Extended End-To-End Anastomosis: Is It The Ideal Technique For Repair of Coarctation of The Aorta In Babies Less Than Six Months of Age?

  • Prof Mohamed-Adel Elgamal, Departments of Congenital & Pediatric Cardiac Surgery, Mansoura University Children's Hospital, Mansoura University, Mansoura,, Egypt
  • Prof Magdy Abou Elkheir, Pediatric Cardiology, and Mansoura University Children's Hospital, Mansoura University, Mansour, Egypt
  • Prof Hala AlMarsafawy, Pediatric Cardiology, Mansoura University Children's Hospital, Mansoura University, Mansour, Egypt
  • A/Prof Mona Hafez, Pediatric Cardiology, Mansoura University Children's Hospital, Mansoura University, Mansour, Egypt

    • Background: Coarctation of the aorta (CoA) presented in the first 6 month of life is almost always associated with variable degree of arch hypoplasia. Resection with end-to-end anastomosis is associated with high recurrence as it does not address the arch hypoplasia..

    Objective: To evaluate extended end-to-end anastomosis (EETEA) as a surgical management of CoA in this age group.

    Patients and Methods: From October 2004 to October 2008, 35 babies were diagnosed to have CoA with arch hypoplasia. Twenty one were males and 14 were females. Age ranged from 10 to 180 days (71 ±12). Weight ranged from 2 to 7.5 Kg. (3.7 ±1.2). Diagnosis was confirmed by Echo-Doppler ,CT angiography and recently by multisclice CT. The approach was through a left posterolateral thoracotomy.
    Results: Mean Z value for the aortic arch was ─3 ±0.3 (range ─2 to─3.5) and for the isthmus ─4 ±0.6 (range ─3 to ─6). Mean intensive care unit stay was 4± 1.7 days (range 2 ─7). There was one operative mortality. Early postoperative complications occurred in 4 patients. Follow up ranged from one to 46 months. Postoperative echo was done at discharge in all patients and after one year in 21 patients with a peak pressure gradient ranged from none to 22 mmHg.(11 ±2.7). No recurrence occurred so far.
    Conclusion: EETEA appeared to be ideal for surgical management of isolated CoA in babies less than six month of life as it addresses distal arch hypoplasia. Long-term follow-up, however, is mandatory for proper evaluation.