Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery
Background: In neonates with critical aortic coarctation (CoA) primary stenting of CoA may serve as therapeutic bridging until definitive surgical repair. Methods: Comparative study of acute and long-term outcome of neonates with critical CoA treated by combined stent-surgery approach, or by primary...
Main Authors: | , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2021-08-01
|
Series: | International Journal of Cardiology Congenital Heart Disease |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S266666852100094X |
id |
doaj-a6f952fb79ae4f40aec022e72f5724b3 |
---|---|
record_format |
Article |
spelling |
doaj-a6f952fb79ae4f40aec022e72f5724b32021-09-01T04:23:12ZengElsevierInternational Journal of Cardiology Congenital Heart Disease2666-66852021-08-014100170Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgeryWalter Knirsch0Martin Schweiger1Daniel Quandt2Hitendu Dave3Oliver Kretschmar4Department of Surgery, Pediatric Heart Center, Pediatric Cardiology and Children's Research Center, University Children's Hospital Zurich, Switzerland; University of Zurich (UZH), Switzerland; Corresponding author. Department of Surgery, Pediatric Heart Center, Pediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.University of Zurich (UZH), Switzerland; Department of Surgery, Pediatric Heart Center, Pediatric Cardiovascular Surgery and Children's Research Center, University Children's Hospital Zurich, SwitzerlandDepartment of Surgery, Pediatric Heart Center, Pediatric Cardiology and Children's Research Center, University Children's Hospital Zurich, Switzerland; University of Zurich (UZH), SwitzerlandUniversity of Zurich (UZH), Switzerland; Department of Surgery, Pediatric Heart Center, Pediatric Cardiovascular Surgery and Children's Research Center, University Children's Hospital Zurich, SwitzerlandDepartment of Surgery, Pediatric Heart Center, Pediatric Cardiology and Children's Research Center, University Children's Hospital Zurich, Switzerland; University of Zurich (UZH), SwitzerlandBackground: In neonates with critical aortic coarctation (CoA) primary stenting of CoA may serve as therapeutic bridging until definitive surgical repair. Methods: Comparative study of acute and long-term outcome of neonates with critical CoA treated by combined stent-surgery approach, or by primary surgery. Complications, re-intervention rate, clinical and echocardiographic findings of left ventricular (LV) function were compared. Results: Between 2012 and 2014, we treated 20 neonates at a median age of 9 (7–51) days and a body weight of 3.6 (3–4.1) kg. We compared 10 neonates treated by primary CoA stenting and secondary surgery with stent removal and CoA repair with 10 age-matched infants with primary surgical CoA repair. There was no early or late mortality. Perioperative complications and rate of re-intervention were comparable in both groups. LV function was reduced before first intervention ejection fraction (EF) 39% (30–42), shortening fraction 27% (20–32), more affected in the stent group, but recovered after stenting until secondary surgery (EF 30% vs. EF 40%, p = 0.01) and normalized until last follow-up (EF 62%, p < 0.01) resp. after primary repair until discharge (EF 60%, p < 0.01). At last follow-up, at an age of 5.2 (4.8–5.9) years, all children were asymptomatic (NYHA 1), without arterial hypertension, or cardiac medication, and with normal LV function and LV mass. Conclusions: The combined stent-surgery approach for critical CoA is an alternative treatment leading to comparable acute and long-term results. It allows LV remodelling before secondary corrective surgery with stent removal via a regular left lateral approach under cross-clamping the aortic arch.http://www.sciencedirect.com/science/article/pii/S266666852100094XCoarctation of the aortic archStentNeonateOutcome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Walter Knirsch Martin Schweiger Daniel Quandt Hitendu Dave Oliver Kretschmar |
spellingShingle |
Walter Knirsch Martin Schweiger Daniel Quandt Hitendu Dave Oliver Kretschmar Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery International Journal of Cardiology Congenital Heart Disease Coarctation of the aortic arch Stent Neonate Outcome |
author_facet |
Walter Knirsch Martin Schweiger Daniel Quandt Hitendu Dave Oliver Kretschmar |
author_sort |
Walter Knirsch |
title |
Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery |
title_short |
Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery |
title_full |
Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery |
title_fullStr |
Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery |
title_full_unstemmed |
Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery |
title_sort |
comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery |
publisher |
Elsevier |
series |
International Journal of Cardiology Congenital Heart Disease |
issn |
2666-6685 |
publishDate |
2021-08-01 |
description |
Background: In neonates with critical aortic coarctation (CoA) primary stenting of CoA may serve as therapeutic bridging until definitive surgical repair. Methods: Comparative study of acute and long-term outcome of neonates with critical CoA treated by combined stent-surgery approach, or by primary surgery. Complications, re-intervention rate, clinical and echocardiographic findings of left ventricular (LV) function were compared. Results: Between 2012 and 2014, we treated 20 neonates at a median age of 9 (7–51) days and a body weight of 3.6 (3–4.1) kg. We compared 10 neonates treated by primary CoA stenting and secondary surgery with stent removal and CoA repair with 10 age-matched infants with primary surgical CoA repair. There was no early or late mortality. Perioperative complications and rate of re-intervention were comparable in both groups. LV function was reduced before first intervention ejection fraction (EF) 39% (30–42), shortening fraction 27% (20–32), more affected in the stent group, but recovered after stenting until secondary surgery (EF 30% vs. EF 40%, p = 0.01) and normalized until last follow-up (EF 62%, p < 0.01) resp. after primary repair until discharge (EF 60%, p < 0.01). At last follow-up, at an age of 5.2 (4.8–5.9) years, all children were asymptomatic (NYHA 1), without arterial hypertension, or cardiac medication, and with normal LV function and LV mass. Conclusions: The combined stent-surgery approach for critical CoA is an alternative treatment leading to comparable acute and long-term results. It allows LV remodelling before secondary corrective surgery with stent removal via a regular left lateral approach under cross-clamping the aortic arch. |
topic |
Coarctation of the aortic arch Stent Neonate Outcome |
url |
http://www.sciencedirect.com/science/article/pii/S266666852100094X |
work_keys_str_mv |
AT walterknirsch comparingacuteandlongtermoutcomeofcriticalneonatalnativeaorticcoarctationtreatedbycombinedstentsurgeryapproachorbyprimarysurgery AT martinschweiger comparingacuteandlongtermoutcomeofcriticalneonatalnativeaorticcoarctationtreatedbycombinedstentsurgeryapproachorbyprimarysurgery AT danielquandt comparingacuteandlongtermoutcomeofcriticalneonatalnativeaorticcoarctationtreatedbycombinedstentsurgeryapproachorbyprimarysurgery AT hitendudave comparingacuteandlongtermoutcomeofcriticalneonatalnativeaorticcoarctationtreatedbycombinedstentsurgeryapproachorbyprimarysurgery AT oliverkretschmar comparingacuteandlongtermoutcomeofcriticalneonatalnativeaorticcoarctationtreatedbycombinedstentsurgeryapproachorbyprimarysurgery |
_version_ |
1721183003629060096 |