Mery Carlos M, Guzmán-Pruneda Francisco A, Carberry Kathleen E, Watrin Carmen H, McChesney Grant R, Chan Joyce G, Adachi Iki, Heinle Jeffrey S, McKenzie E Dean, Fraser Charles D
Division of Congenital Heart Surgery, Texas Children's Hospital, and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Division of Congenital Heart Surgery, Texas Children's Hospital, and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg. 2014 Aug;98(2):625-33; discussion 633. doi: 10.1016/j.athoracsur.2014.04.051. Epub 2014 Jun 10.
The optimal treatment for infants with aortic coarctation and hypoplastic aortic arch is controversial. The goal of this study was to report the short-term and mid-term outcomes of aortic arch advancement (AAA) in infants with hypoplastic aortic arch.
All infants who underwent AAA at our institution from 1995 to 2012 were included. AAA consisted of coarctectomy and end-to-side anastomosis of the descending aorta to the distal ascending aorta/proximal arch through a median sternotomy. The cohort was divided into four groups: (1) isolated AAA (n=29, 11%), (2) AAA with closure of ventricular septal defect (n=56, 20%), (3) AAA with other biventricular repairs (n=115, 42%), and (4) AAA as part of single-ventricle palliation (n=75, 27%).
The cohort included 275 patients: 125 (45%) were female, and the median age was 14 days (interquartile range, 7-34 days). Genetic abnormalities were present in 48 patients (17%). Neurologic adverse events occurred in 3 patients (1%), all in group 4. Left bronchial compression was seen in 2 patients (0.7%); only one required intervention. Vocal cord dysfunction was noted in 36 of 95 patients (38%) on routine laryngoscopy. Only 1 patient had clinical residual dysfunction at the last follow-up visit. Perioperative mortality was 3% (n=8). At a median follow-up time of 6 years, 8 patients (3%) had reinterventions at a median time of 5 months (3-17 months) after repair.
AAA is a safe, effective, and durable operation with low rates of adverse events and mid-term reintervention. The advantages include native tissue-to-tissue reconstruction and preserved potential for growth. As such, it is the ideal technique for the management of hypoplastic aortic arch in neonates and infants.
主动脉缩窄合并主动脉弓发育不良的婴儿的最佳治疗方法存在争议。本研究的目的是报告主动脉弓发育不良的婴儿行主动脉弓推进术（AAA）的短期和中期结果。
纳入1995年至2012年在本机构接受AAA手术的所有婴儿。AAA包括通过正中胸骨切开术进行缩窄切除术以及降主动脉与升主动脉远端/近端弓的端侧吻合术。该队列分为四组：（1）孤立性AAA（n = 29，11%），（2）AAA合并室间隔缺损闭合（n = 56，20%），（3）AAA合并其他双心室修复（n = 115，42%），以及（4）AAA作为单心室姑息治疗的一部分（n = 75，27%）。
该队列包括275例患者：125例（45%）为女性，中位年龄为14天（四分位间距，7 - 34天）。48例患者（17%）存在基因异常。3例患者（1%）发生神经系统不良事件，均在第4组。2例患者（0.7%）出现左支气管受压；仅1例需要干预。95例患者中有36例（38%）在常规喉镜检查时发现声带功能障碍。在最后一次随访时，仅1例患者存在临床残余功能障碍。围手术期死亡率为3%（n = 8）。中位随访时间为6年时，8例患者（3%）在修复后中位时间5个月（3 - 17个月）进行了再次干预。
AAA是一种安全、有效且持久的手术，不良事件发生率和中期再次干预率较低。其优点包括自体组织对组织重建以及保留生长潜力。因此，它是新生儿和婴儿主动脉弓发育不良治疗的理想技术。
