Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Eur J Cardiothorac Surg. 2019 Feb 1;55(2):331-337. doi: 10.1093/ejcts/ezy241.
Surgical repair of coarctation of the aorta (CoA) is often possible through left thoracotomy and without the use of cardiopulmonary bypass. Recent studies reporting the outcome after CoA repair through left thoracotomy are limited. Therefore, the aim of this study is to evaluate the results of CoA repair through left thoracotomy in children who were operated on in our centre over the past 21 years.
From January 1995 to December 2016, 292 patients younger than 18 years underwent primary CoA repair through left thoracotomy at our 2 institutions. Peri- and postoperative data and follow-up data collected from our hospital and the referring hospitals were retrospectively reviewed.
Median age at operation was 64 days (range 2 days-17 years). Most patients underwent the resection of the CoA followed by an (extended) end-to-end anastomosis (93%). Six patients died perioperatively and 2 more patients died during the follow-up, of which 7 patients had other major comorbidities. Actuarial survival was 97% at 5 years, 96% at 10 years and 96% at 15 years. Second arch interventions due to recoarctation were performed in 9.9% (n = 29) of patients, consisting of balloon dilatation in all but 2 patients. Recoarctation occurred significantly more often after initial repair in the neonatal period (21%) and could occur as late as 14 years after initial surgery. There were 7 re-recoarctations, and 14% of patients were on hypertensive medication during the follow-up.
Repair of CoA through left thoracotomy is a safe procedure with low rates of mortality. The long-term follow-up is necessary due to the significant risk of recoarctation requiring reintervention.
主动脉缩窄（CoA）的外科修复通常可以通过左开胸手术完成，而无需使用体外循环。最近报告通过左开胸手术修复 CoA 后结果的研究有限。因此，本研究旨在评估过去 21 年在我们中心接受手术的儿童通过左开胸手术修复 CoA 的结果。
1995 年 1 月至 2016 年 12 月，我们 2 家机构共有 292 名年龄小于 18 岁的患者通过左开胸手术进行了初次 CoA 修复。回顾性地审查了从我们医院和转诊医院收集的围手术期和术后数据以及随访数据。
手术时的中位年龄为 64 天（范围为 2 天至 17 岁）。大多数患者接受了 CoA 的切除术，然后进行了（扩大）端端吻合术（93%）。6 名患者在围手术期死亡，2 名患者在随访期间死亡，其中 7 名患者有其他重大合并症。5 年、10 年和 15 年的存活率分别为 97%、96%和 96%。由于再狭窄而进行的第二次弓干预在 9.9%（n=29）的患者中进行，除了 2 名患者之外，所有患者均进行了球囊扩张。新生儿期初次修复后再狭窄明显更常见（21%），甚至在初次手术后 14 年也可能发生。再狭窄发生 7 次，14%的患者在随访期间需要服用高血压药物。
通过左开胸手术修复 CoA 是一种安全的手术方法，死亡率低。由于再狭窄需要再次干预的风险很大，因此需要进行长期随访。
