Elena Levchenko, Andrey Svobodov, Margarita Tymanyan

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – B

Abstract

Methods:Retrospective analysis of the condition of 1116 patients operated on for aortic coarctation (AoCo) at 1 year of age for the period 2005-2015 in theBSCCS.AoCo repair through left thoracotomywas performed in 1023 patients (91,7%; I group): anastomosis "end-to-side" 18 (1,76%), "end-to-end" 963 (94,13%), isthmoplasty with subclavian artery 25 (2,4%), patch isthmoplasty 17 (1,67%). Balloon angioplasty (BA) was performed in 93 patients (8,3%; the II group). AoCo was combined with othercorrectionrequiring CHD in432 of patients

Results: Time of observation in catamnesis was 4.3 [2,7…7,1] years. There were no lethal outcomes not associated with surgical reinterventions. Reoperation (including staged correction of combined CHD) was performed in 301 (27%) cases. 111 children were operated recoarctation (reAoCo) (9,9%) in 182 [124…242] days after primary correction with a lethality rate of 4% (n=3): 75 children (7,3%) from the I group in 210 [150...305] days and 36 (38,7%) from the II group in 79 [8,75...156,75] days. Freedom from reAoCo to 12 years was 80%.

Risk factors of reAoCo development in group I were: age <45 days in primary surgery (odds ratio (OR) 4,5; 95% confidence interval (CI) 0,634-7,7, p=0,000), weight <3.8 kg (OR5,8; 95%CI 0,644-0,75, p=0,000), patch isthmoplasty (OR5,5; 95%CI 1,9-16,3, p=0,003); in group II: Z-score of isthmus ˂-4,1 (p=0000) and age <42 days (OR7,5; 95%CI 2,8-19,7; p=0,000).

ReAoCo formed significantly (p=0.000) more often and faster in group II. Freedom from reAoCo for group I was 87% (1 year) and 79,5% (12 years), for group II – 50% and 40%, respectively.

Conclusion: resection of the AoCo through left thoracotomy has good long-term results, excepting patch isthmoplasty. BA may be recommended as a stage I of the correction of AoCo for complicated patients with high risk of performing an open surgery.