| Subclavian flap aortoplasty: still a safe, reproducible, and effective treatment for infant coarctation. | |
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MedLine Citation:
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PMID: 17276693 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Subclavian flap repair of infant coarctation has been criticized and in many centers abandoned in favor of resection with end-to-end anastomosis. The goal of this study was to examine intermediate and long-term results of infant subclavian flap aortoplasty, which has been the preferred technique at our institution over the last two decades. METHODS: Our patient database identified all infants (age<1 year) who underwent repair of isthmic coarctation via thoracotomy between January 1984 and December 2004. Procedure details and late results were collected by retrospective review of hospital and clinic data. Follow-up was 95.8% complete at a mean of 6.7 years. RESULTS: Between January 1984 and December 2004, 119 infants underwent isolated subclavian flap repair of coarctation. Mean age and weight at operation were 35+/-52 days (range 1-269 days) and 3.5+/-1.3kg (range 0.7-9.3kg), respectively. Concomitant pulmonary artery banding was performed in 22% (26/119). In-hospital mortality was 4% (5/119) and cumulative late mortality was 6% (7/114) of patients with long-term follow-up. Actuarial survival at 1, 5, and 10 years was 91, 85, and 85%, respectively. Overall re-intervention rate for re-stenosis was 11% (12/114); 10 patients (9%) underwent balloon angioplasty while 3 patients (3%) required operative revision. All re-stenoses occurred in the descending aorta, and all occurred in patients who had undergone neonatal repair. At late follow-up, there were no significant neurologic events (left recurrent laryngeal nerve injury, stellate ganglion dysfunction, or paraplegia), no clinically significant ischemic arm complications, and no flap aneurysms. CONCLUSIONS: Subclavian flap aortoplasty remains our procedure of choice for isthmic coarctation, as it is a simple, technically straightforward technique with a low incidence of re-stenosis and serious early and late morbidity. Furthermore, subclavian flap re-stenoses are easily treated with percutaneous intervention and seldom require surgical re-intervention via thoracotomy. |
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Authors:
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Christopher J Barreiro; Trevor A Ellison; Jason A Williams; Megan L Durr; Duke E Cameron; Luca A Vricella |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2007-02-05 |
Journal Detail:
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Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Volume: 31 ISSN: 1010-7940 ISO Abbreviation: Eur J Cardiothorac Surg Publication Date: 2007 Apr |
Date Detail:
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Created Date: 2007-03-19 Completed Date: 2007-06-28 Revised Date: 2008-02-28 |
Medline Journal Info:
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Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: Germany |
Other Details:
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Languages: eng Pagination: 649-53 Citation Subset: IM |
Affiliation:
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Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aortic Coarctation
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complications,
mortality,
surgery* Aortic Valve Stenosis / complications, surgery Female Humans Infant Kaplan-Meiers Estimate Male Postoperative Complications / etiology Recurrence Reoperation Reproducibility of Results Retrospective Studies Subclavian Artery / surgery* Surgical Flaps* Treatment Outcome Vascular Surgical Procedures / adverse effects, methods* |
| Comments/Corrections | |
Comment In:
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Eur J Cardiothorac Surg. 2007 Nov;32(5):824; author reply 824-5
[PMID:
17869535
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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