Complications of Surgical Treatment of Aortic Arch Hypoplasia in Infants

Keywords: congenital heart defects, residual hypertension, recurrent obstruction, heart failure, balloon dilatation

Abstract

Aortic arch surgery in neonatal patients remains problematic despite the constant evolution and improvement of treatment methods. Even after successful correction, complications associated with aortic arch reconstruction are more common in young children. This is especially true for newborns and infants with concomitant complex congenital intracardiac abnormalities. Despite the risk of postoperative complications, the risk of surgical treatment of aortic arch hypoplasia is lower than the cumulative hazards associated with the natural course of this defect. That is why pediatric cardiologists are obliged to constantly monitor the operated patients in order to timely identify and treat complications.

The aim. To analyze the complications in the early and remote postoperative periods after the reconstruction of the aortic arch in the neonatal period.

Materials and methods. The work is based on a study of 445 patients under 1 year of age, who underwent surgical treatment of aortic arch hypoplasia from 2010 to 2019. The criterion for inclusion in the study group was the presence of isolated hypoplasia of the aortic arch and combination with other defects, which were corrected by two-ventricular repair. The majority of the treated patients were male (284 [63.8% of the total number of patients]). The median age of the patients was 0.7 months (0.3; 2.7). The median body weight of the patients was 3.7 kg (3.25; 4.59).

Results. At the hospital stage, 12 patients died, which accounted for 3.1% of the entire cohort of operated patients. Complications occurring at the hospital stage were recorded in 75 (16.8%) patients. In the long term, a complicated course was observed in 72 (16.6%) children. Among them, the most frequent complications were: respiratory failure requiring prolonged mechanical ventilation (36.9%), dilated sternum due to severe heart failure (17.4%), diaphragmatic paresis (8.7%), chylothorax (5.4%). In the long term, 47 (10.5%) patients developed aortic arch restenosis, which required reinterventions. The proportion of patients without reoperations in the follow-up period according to the KaplanMeier analysis was 93.4% after 1 year, 91.2% after 4 years, and 76.5% after 9 years. Residual hypertension requiring medical treatment was reported in 59 (13.2%) patients.

Conclusions. Aortic arch hypoplasia is a complex congenital heart disease; its surgical treatment is accompanied by the development of complications both in the early and in the long-term period. The main complications at the hospital stage were respiratory and heart failures which were associated with the presence and correction of concomitant congenital heart defects. The main complication of the follow-up period was reobstruction at the level of the aortic arch. Anatomical correction of reobstruction is safe with both endovascular and surgical treatments.

References

  1. Brown JW, Ruzmetov M, Hoyer MH, Rodefeld MD, Turrentine MW. Recurrent coarctation: is surgical repair of recurrent coarctation of the aorta safe and effective? Ann Thorac Surg. 2009;88(6):1923-30; discussion 1930-1. https://doi.org/10.1016/j.athoracsur.2009.07.024
  2. Alkashkari W, Albugami S, Althobaiti M, Alfouti M, Alrahimi J, Kinsara A, Alzahrani A, Fernandez JA, Tash A, Aburemish H. Transcatheter Intervention for Late Complications after Aortic Coarctation Surgical Repair. J Clin Trials. 2020;10:402. https://doi.org/10.35248/2167-0870.20.10.402
  3. Ghani MOA, Raees MA, Harris GR, Shannon CN, Nicholson GT, Bichell DP. Reintervention After Infant Aortic Arch Repair Using a Tailored Autologous Pericardial Patch. Ann Thorac Surg. 2021;111(3):973-9. https://doi.org/10.1016/j.athoracsur.2020.04.091
  4. Roeleveld PP, Zwijsen EG. Treatment Strategies for Paradoxical Hypertension Following Surgical Correction of Coarctation of the Aorta in Children. World J Pediatr Congenit Heart Surg. 2017;8(3):321-31. https://doi.org/10.1177/2150135117690104
  5. Donazzan L, Crepaz R, Stuefer J, Stellin G. Abnormalities of aortic arch shape, central aortic flow dynamics, and distensibility predispose to hypertension after successful repair of aortic coarctation. World J Pediatr Congenit Heart Surg. 2014;5(4):546-53. https://doi.org/10.1177/2150135114551028
  6. Maddali MM, Kandachar PS, Al-Hanshi S, Al Ghafri M, Valliattu J. Mechanical cause for acute left lung atelectasis after neonatal aortic arch repair with arterial switch operation: Conservative management. Ann Card Anaesth. 2017;20(2):252-55. https://doi.org/10.4103/aca.ACA_197_16
  7. Ruzmetov M, Vijay P, Rodefeld MD, Turrentine MW, Brown JW. Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: a 38-year single institution experience. J Pediatr Surg. 2009;44(7):1328-32. https://doi.org/10.1016/j.jpedsurg. 2008.11.062
  8. Zoghbi J, Serraf A, Mohammadi S, Belli E, Lacour Gayet F, Aupecle B, Losay J, Petit J, Planché C. Is surgical intervention still indicated in recurrent aortic arch obstruction? J Thorac Cardiovasc Surg. 2004;127(1):203-12. https://doi.org/10.1016/s0022-5223(03)01290-x
  9. Mery CM, Khan MS, Guzmán-Pruneda FA, Verm R, Umakanthan R, Watrin CH, Adachi I, Heinle JS, McKenzie ED, Fraser CD Jr. Contemporary results of surgical repairof recurrent aortic arch obstruction. Ann Thorac Surg. 2014;98(1):133-40; discussion 140-1. https://doi.org/10.1016/j.athoracsur.2014.01.065
  10. Reich O, Tax P, Bartáková H, Tomek V, Gilík J, Lisy J, Radvansky J, Matejka T, Tláskal T, Svobodová I, Chaloupecky V, Skovránek J. Long-term (up to 20 years) results of percutaneous balloon angioplasty of recurrent aortic coarctation without use of stents. Eur Heart J. 2008;29(16):2042-8. https://doi.org/10.1093/eurheartj/ehn251
  11. Swartz MF, Morrow D, Atallah-Yunes N, Cholette JM, Gensini F, Kavey RE, Alfieris GM. Hypertensive changes within the aortic arch of infants and children with isolated coarctation. Ann Thorac Surg. 2013;96(1):190-5. https://doi.org/10.1016/j.athoracsur.2013.04.007
  12. Vigneswaran TV, Sinha MD, Valverde I, Simpson JM, Charakida M. Hypertension in Coarctation of the Aorta: Challenges in Diagnosis in Children. Pediatr Cardiol. 2018;39(1):1-10. https://doi.org/10.1007/s00246-017-1739-x.
  13. Jang WS, Kim WH, Choi K, Nam J, Kim JT, Lee JR, Kim YJ, Kim GB. Aortopexy with preoperative computed tomography and intraoperative bronchoscopy for patients with central airway obstruction after surgery for congenital heart disease: postoperative computed tomography results and clinical outcomes. Pediatr Cardiol. 2014;35(6):914-21. https://doi.org/10.1007/s00246-014-0875-9
  14. Czobor NR, Roth G, Prodán Z, Lex DJ, Sápi E, Ablonczy L, Gergely M, Székely EA, Gál J, Székely A. Chylothorax after pediatric cardiac surgery complicates short-term but not long-term outcomes-a propensity matchedanalysis. J Thorac Dis. 2017;9(8):2466-75. https://doi.org/10.21037/jtd.2017.07.88
  15. Kahraman D, Keskin G, Khalil E, Dogan OF. Ten-Year Clinical Experience on Chylothorax after Cardiovascular Surgery. Heart Surg Forum. 2020;23(1):E081-E087. https://doi.org/10.1532/hsf.2655
  16. Paul S, Altorki NK, Port JL, Stiles BM, Lee PC. Surgical management of chylothorax. Thorac Cardiovasc Surg. 2009;57(4):226-8. https://doi.org/10.1055/s-0029-1185457
  17. Slater BJ, Rothenberg SS. Thoracoscopic Thoracic Duct Ligation for Congenital and Acquired Disease. J Laparoendosc Adv Surg Tech A. 2015;25(7):605-7. https://doi.org/10.1089/lap.2014.0360
  18. Pourmoghadam KK, DeCampli WM, Ruzmetov M, Kosko J, Kishawi S, O’Brien M, Cowden A, Piggott K, Fakioglu H. Recurrent Laryngeal Nerve Injury and Swallowing Dysfunction in Neonatal Aortic Arch Repair. Ann Thorac Surg. 2017;104(5):1611-8. https://doi.org/10.1016/j.athoracsur.2017.03.080
  19. El Tantawy AE, Imam S, Shawky H, Salah T. Diaphragmatic nerve palsy after cardiac surgery in children in Egypt: outcome and debate in management. World J Pediatr Congenit Heart Surg. 2013;4(1):19-23. https://doi.org/10.1177/2150135112454444
  20. Baker CJ, Boulom V, Reemtsen BL, Rollins RC, Starnes VA, Wells WJ. Hemidiaphragm plication after repair of congenital heart defects in children: quantitative return of diaphragm functionovertime.JThoracCardiovascSurg.2008;135(1):56-61. https://doi.org/10.1016/j.jtcvs.2007.09.031
Published
2021-12-22
How to Cite
Truba, I. P., Dziuryi, I. V., Sekelyk, R. I., Golovenko, O. S., & Lazoryshynets, V. V. (2021). Complications of Surgical Treatment of Aortic Arch Hypoplasia in Infants. Ukrainian Journal of Cardiovascular Surgery, (4 (45), 63-70. https://doi.org/10.30702/ujcvs/21.4512/TD049-6370

Most read articles by the same author(s)

1 2 > >>