Application of End-to-side Anastomosis for Coarctation of the Aorta with Cardiac Lesions in Neonates and Infants_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CUI Hujun , CHEN Xinxin , XIA Yuansheng

Department of Heart Center，Guangzhou Women and Children’s Medical Center，Guangzhou 510623，P. R. China;

Corresponding author：

Keywords：

Coarctation of aorta; End-to-side anastomasis

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Objective To compare the advantages of reconstructing the aorta by end-to-side anastomosis with extended end-to-end anastomosis for aortic coarctation （CoA） with cardiac lesions in neonates and infants. Methods There were 63 neonates and infants who underwent median full sternotomy for correction of CoA and cardiaclesions from January 2008 to July 2011 in Guangzhou Women and Children’s Medical Center. These patients were divided into two groups： extended end-to-end anastomosis was performed in 24 patients （end-to-end group, 17 males and 7 females with their mean age of 4.6±2.9 months）and end-to-side anastomosis in 39 patients （end-to-side group, 24 males and 15 females with their mean age of 3.4±2.6 months）. We compared the two groups with regard to postoperative mortality, morbidity and difference in blood pressure between the lower and upper extremities. Results The percentage of newborn patient（23.1% vs. 4.2%; χ2=3.979, P=0.045）and presence of pre-operative acidosis（15.4% vs. 0%; χ2=4.080, P=0.048）were significantly higher in end-to-side group than those in end-to-end group. There was no postoperative death in end-to-end group and 1 patient died after surgery in end-to-side group（2.6%）. The average duration of circulatory arrest in end-to-side group was significantly shorter than that in end-to-end group （18.6±2.7 min vs.23.4±3.7 min, F=14.617, P=0.000）. At the time back to cardiac intensive care unit, the percentage of patients whose difference in systolic pressure between radial and femoral artery ＜ 5 mm Hg, 5-15 mm Hg, and＞ 15 mm Hg was 20.8%, 45.8% and 33.3% respectively in end-to-end group, and 97.4%, 2.6% and 0% respectively in end-to-side group（χ2=40.380，P=0.000）. Twenty-four hours after surgery, the percentage of patients whose difference in systolic pressure between radial and femoral artery＜ 5 mm Hg, 5-15 mm Hg, and＞ 15 mm Hgwas 45.8%, 41.7% and 12.5% respectively in end-to-end group, and 100%, 0% and 0% respectively in end-to-side group （χ2=26.620, P=0.000）. All the surviving 62 patients were followed up for 2-36 months, and there was no patient with angeioma or re-stenosis needing intervention in either group during follow-up. Conclusion End-to-side anostomosis is a safe and effective method for treating CoA with cardiac lesions and eliminating residual stenosis in neonates and infants.

Citation： CUI Hujun,CHEN Xinxin,XIA Yuansheng,et al .. Application of End-to-side Anastomosis for Coarctation of the Aorta with Cardiac Lesions in Neonates and Infants. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(2): 159-162. doi: Copy

1.	Jonas RA, 主编, 刘锦纷, 主译. 先天性心脏病外科综合治疗学. 北京：北京大学出版社, 2009. 207-223.
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6.	Backer CL, Mavroudis C, Zias EA, et al. Repair of coarctation with resection and extended end-to-end anastomosis. Ann Thorac Surg, 1998, 66（4）: 1365-1371.
7.	鲁亚南, 刘锦纷, 徐志伟, 等. 主动脉弓补片成形术治疗婴幼儿主动脉缩窄合并主动脉弓发育不良. 中国胸心血管外科临床杂志, 2010, 17（6）：455-458.
8.	罗国华, 闫军, 刘迎龙, 等. 婴幼儿主动脉缩窄合并心内复杂畸形的一期手术治疗. 中国循环杂志, 2010, 25（2）：132-134.
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10.	曾洁敏, 黄萍, 陈欣欣. 主动脉缩窄术后血管结构和功能变化. 中华胸心血管外科杂志, 2010, 26（5）: 354-355.
11.	郑景浩, 苏肇伉, 丁文祥. 端端吻合术在小婴儿主动脉缩窄中的应用. 中华胸心血管外科杂志, 2001, 17（6）：324-325.
12.	Kaushal S, Backer CL, Patel JN, et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg, 2009,88（6）：1932-1938.
13.	Bleakney CA, Zafar F, Fraser CD Jr. Circumflex right aortic arch with associated hypoplasia and coarctation：repair by aortic arch advancement and end-to-side anastomosis. Ann Thorac Surg, 2011, 91（2）：624-626.
14.	Yamashiro M, Takahashi Y, Ando M, et al. End-to-side anastomosis for coarctation of the aorta and type A aortic arch interruption with hypoplastic aortic arch. Jpn J Thorac Cardiovasc Surg, 2006, 54（7）： 273-277.
15.	Younoszai AK, Reddy VM, Hanley FL, et al. Intermediate term follow-up of the end-to-side aortic anastomosis for coarctation of the aorta. Ann Thorac Surg, 2002, 74（5）： 1631-1634.
16.	Sebening C, Jakob H, Tochtermann U, et al. Vascular tracheobronchial compression syndromes--experience in surgical treatment and literature review. Thorac Cardiovasc Surg, 2000,48（3）：164-174.
17.	Schreiber C, Eicken A, Vogt M, et al. Repair of interrupted aortic arch：results after more than 20 years. Ann Thorac Surg, 2000, 70（6）：1896-1900.
18.	陈欣欣, 张镜芳, 庄建, 等. 经胸骨正中切口一期矫治小儿主动脉缩窄及合并畸形. 中华胸心血管外科杂志, 2006, 22（6）：374-376.

1. 　Jonas RA, 主编, 刘锦纷, 主译. 先天性心脏病外科综合治疗学. 北京：北京大学出版社, 2009. 207-223.
2. 　Mavroudis C, Baker CL. Pediatric Cardiac Surgery. The 3rd editon. Elsevier（Singapore）：Pte Ltd Singapore, 2004. 228-241.
3. 　Serfontein SJ, Kron IL. Complications of coarctation repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu ,2002, 5：206-211.
4. 　Heger M, Willfort A, Neunteufl T, et al. Vascular dysfunction after coartctation repair is related to the age at surgery. Int J Cardiol, 2005, 99（2）：295-299.
5. 　Zannini L, Gargiulo G, Albanese SB, et al. Aortic coarctation with hypoplastic arch in neonates: a spectrum of anatomic lesions requiring different surgical options. Ann Thorac Surg, 1993, 56（2）: 288-294.
6. 　Backer CL, Mavroudis C, Zias EA, et al. Repair of coarctation with resection and extended end-to-end anastomosis. Ann Thorac Surg, 1998, 66（4）: 1365-1371.
7. 　鲁亚南, 刘锦纷, 徐志伟, 等. 主动脉弓补片成形术治疗婴幼儿主动脉缩窄合并主动脉弓发育不良. 中国胸心血管外科临床杂志, 2010, 17（6）：455-458.
8. 　罗国华, 闫军, 刘迎龙, 等. 婴幼儿主动脉缩窄合并心内复杂畸形的一期手术治疗. 中国循环杂志, 2010, 25（2）：132-134.
9. 　Huber C, Mimic B, Oswal N, et al. Outcomes and re-interventions after one-stage repair of transposition of great arteries and aortic arch obstruction. Eur J Cardiothorac Surg, 2011, 39（2）：213-220.
10. 　曾洁敏, 黄萍, 陈欣欣. 主动脉缩窄术后血管结构和功能变化. 中华胸心血管外科杂志, 2010, 26（5）: 354-355.
11. 　郑景浩, 苏肇伉, 丁文祥. 端端吻合术在小婴儿主动脉缩窄中的应用. 中华胸心血管外科杂志, 2001, 17（6）：324-325.
12. 　Kaushal S, Backer CL, Patel JN, et al. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg, 2009,88（6）：1932-1938.
13. 　Bleakney CA, Zafar F, Fraser CD Jr. Circumflex right aortic arch with associated hypoplasia and coarctation：repair by aortic arch advancement and end-to-side anastomosis. Ann Thorac Surg, 2011, 91（2）：624-626.
14. 　Yamashiro M, Takahashi Y, Ando M, et al. End-to-side anastomosis for coarctation of the aorta and type A aortic arch interruption with hypoplastic aortic arch. Jpn J Thorac Cardiovasc Surg, 2006, 54（7）： 273-277.
15. 　Younoszai AK, Reddy VM, Hanley FL, et al. Intermediate term follow-up of the end-to-side aortic anastomosis for coarctation of the aorta. Ann Thorac Surg, 2002, 74（5）： 1631-1634.
16. 　Sebening C, Jakob H, Tochtermann U, et al. Vascular tracheobronchial compression syndromes--experience in surgical treatment and literature review. Thorac Cardiovasc Surg, 2000,48（3）：164-174.
17. 　Schreiber C, Eicken A, Vogt M, et al. Repair of interrupted aortic arch：results after more than 20 years. Ann Thorac Surg, 2000, 70（6）：1896-1900.
18. 　陈欣欣, 张镜芳, 庄建, 等. 经胸骨正中切口一期矫治小儿主动脉缩窄及合并畸形. 中华胸心血管外科杂志, 2006, 22（6）：374-376.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of End-to-side Anastomosis for Coarctation of the Aorta with Cardiac Lesions in Neonates and Infants

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