Late results of surgical treatment of the aortal arch hypoplasia in newborns and babies

Abstract

Objective. To conduct the analysis of late results of the aortal arch reconstruction in newborns and babies, basing on determination of the risk factors for lethality and reoperations. Materials and methods. In 2010 - 2019 yrs in the Amosov National Institute of Cardiovascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardiosurgery the aortal arch reconstruction was performed in 445 patients, ageing up to 1 year old, suffering coarctation and hypoplasia of one or several aortal segments. Into the investigation were included the patients with a two-ventricular physiology and further two-ventricular correction were included. There were 161 (36.2%) girls and 284 (63.8%) boys with the age median 0.7 mo [0.3; 2.7], while the body mass median – 3.7 kg [3.25; 4.59], and the body surface square median – 0.23 m2 [0.20;0.27]. Echocardiography was the main diagnostic method for the failure as well as for estimation of immediate and late results. Results. Overall lethality have constituted 3.3%, the hospital one – 2.7%, lethality in late period of observation – 0.7%. The observation period have lasted from 1 mo till 9.4 yrs, (2.8 ±2.5) yrs at average. Reoperations on aortal arch were performed in 47 (10.5%) patients: in 12 – surgical aortal arch rereconstruction, in 27 – balloon angioplasty, and in 8 patients both methods were used. The risk factors for lethality after the aortal arch reconstruction in the patients, ageing up to 1 yr old were revealed: the patients’ age on the operation moment lesser than 0.9 mo, the body mass lesser than 2.6 kg, durable operation, presence of concurrent inborn heart failures, residual hypoplasia of the aortal segments A and B. Low mass and the surface square of the body, presence of the aortal arch segments hypoplasia preoperatively, residual pressure gradient on the aortal arch more than 20 mm Hg, hypoplasia of any aortal arch segments after reconstruction have constituted the risk factors for reoperations. Conclusion. Surgical treatment of the aortal arch hypoplasia in newborns and babies is effective and giving good immediate and late results. Anatomic correction of secondary obstruction on the aortal arch level is secure, with low indices of lethality and reoperations, and performed either surgically or endoscopically. Taking into account the risk factors revealed for lethality and reoperations on aortal arch, have permitted to improve the results of treatment of the aortal arch hypoplasia in patients ageing up to 1 yr old.

Keywords

• aortal arch hypoplasia; the risk factors for lethality; reoperations; newborns; babies.