Zhao Zhenjiang, Wu Chun, Dai Jiangtao, Lu Siwei, He Ling, Tian Jie, Jin Xin, Pan Zhengxia
Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
J Thorac Dis. 2025 Feb 28;17(2):959-968. doi: 10.21037/jtd-24-1635. Epub 2025 Feb 27.
Aortic coarctation (CoA) is a congenital heart disease that usually combines various cardiovascular malformations, including hypoplastic aortic arch (HAA). We explore end-to-side anastomosis (ESA) and autologous pulmonary artery patch (APAP) in CoA with HAA, to provide more clinical experience.
This is a single-center retrospective study. The target population is patients with aortic stenosis and HAA who underwent surgery between 2015 and 2021. All cases included were consecutive, and no instances were omitted due to absent data, lack of consent, or other factors. Collect information on gender, age, and weight at the time of the operation, detailed information on the constricted segment and pressure gradient evaluated by echocardiography and computed tomography (CT), and other factors of patients, and these data were analyzed by statistical methods.
Ninety-six patients (67 males and 29 females) with median age of 76 (41.75, 128.50) days and median weight of 4.20 (3.70, 5.10) kg were enrolled. The follow-up period was 46.20 (34.40, 54.70) months. The patients were divided into two groups based on surgery: ESA (G1, 59) and APAP (G2, 37). The combined cardiovascular malformations were treated simultaneously. None of the patients had neurological events or renal failure, and three died early after the operation. Finally, 93 patients were successfully followed-up. Cox regression showed that ESA was a risk factor for aortic arch geometry is closer to Gothic (G-AAg), elevated blood pressure (EBp), and aortic recoarctation (reCoA) after surgery. In G1, 18 patients had G-AAg (P=0.03), 13 had EBp (P=0.041), and 12 had reCoA (P=0.041), all of which were significantly higher than those in G2 (three had G-AAg, one of whom had EBp and reCoA).
It is safe and effective to repair CoA and HAA and other cardiovascular malformations through one-stage median sternotomy. Compared with ESA, APAP can lower the risks of G-AAg, EBp, and reCoA. Although APAP takes longer, the proper application of selective antegrade cerebral perfusion may lower the risks. We recommend expanding the indications for APAP when circumstances allow, which will benefit patients.
主动脉缩窄（CoA）是一种先天性心脏病，通常合并多种心血管畸形，包括主动脉弓发育不全（HAA）。我们探讨端侧吻合术（ESA）和自体肺动脉补片（APAP）在合并HAA的CoA中的应用，以提供更多临床经验。
这是一项单中心回顾性研究。目标人群为2015年至2021年间接受手术的主动脉缩窄合并HAA患者。所有纳入病例均为连续病例，无因数据缺失、缺乏同意或其他因素而遗漏的情况。收集患者手术时的性别、年龄和体重信息，超声心动图和计算机断层扫描（CT）评估的狭窄段详细信息和压力梯度，以及患者的其他因素，并对这些数据进行统计学分析。
共纳入96例患者（男67例，女29例），中位年龄76（41.75，128.५०）天，中位体重4.20（3.70，5.10）kg。随访时间为46.20（34.40，54.70）个月。根据手术方式将患者分为两组：ESA组（G1，59例）和APAP组（G2，37例）。同时治疗合并的心血管畸形。所有患者均未发生神经系统事件或肾衰竭，3例术后早期死亡。最后，93例患者成功随访。Cox回归显示，ESA是术后主动脉弓形态更接近哥特式（G-AAg）、血压升高（EBp）和主动脉再缩窄（reCoA）的危险因素。在G1组中，18例患者有G-AAg（P = 0.03），13例有EBp（P = 0.041），12例有reCoA（P = 0.041），均显著高于G2组（3例有G-AAg，其中1例有EBp和reCoA）。
通过一期正中胸骨切开术修复CoA和HAA及其他心血管畸形是安全有效的。与ESA相比，APAP可降低G-AAg、EBp和reCoA的风险。虽然APAP手术时间较长，但适当应用选择性顺行脑灌注可能降低风险。我们建议在情况允许时扩大APAP的适应证，这将使患者受益。
