Comparative analysis of the effectiveness of coarctation surgery between neonates and infants

Yilmaz, Mustafa; Turkcan, Başak Soran; Ecevit, Ata Niyazi; Şahan, Yasemin Özdemir; Atalay, Atakan

doi:10.1590/1806-9282.20231626

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Assoc. Med. Bras. 70 (5) • 2024 • https://doi.org/10.1590/1806-9282.20231626 copy

Comparative analysis of the effectiveness of coarctation surgery between neonates and infants

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

This study aimed to compare the effectiveness of resection and extended end-to-end anastomosis between neonate and infant patients with coarctation.

METHODS:

This study was designed retrospectively and included 41 neonate (<30 days) and infant (30 days to 1 year) patients who were operated on using the resection and extended end-to-end anastomosis technique for aortic coarctation. Preoperative aortic annulus diameters and Z scores, all aortic arch diameters and Z scores, the presence of hypoplastic aortic segment, and the presence of prematurity were reviewed in both groups. Subsequently, we investigated whether these parameters were statistically related to the residual gradient in the operation area, whether there was a need for early re-intervention, and what was the incidence of mortality in the early postoperative period. In addition, the aortic arch Z scores of the patients at 6 months postoperatively were examined.

RESULTS:

While the mean age (p<0.001), body weight (p<0.001), and proximal arch Z score (p=0.029) were found to be significantly lower in the neonate group than in the infant group, the total length of the intensive care unit stay (p=0.013) and the total length of hospital stay (p=0.017) were found to be significantly higher. In addition, significant enlargement was detected in the proximal arch, distal arch, and isthmus segments in both patient groups.

CONCLUSION:

The resection and extended end-to-end anastomosis is an equally effective technique that can provide a marked decrease in gradient in the coarctation area and a significant enlargement of the aortic arch segments in the early period after coarctation repair in both neonate and infant patients.

KEYWORDS:
Coarctation; Newborn; Infant

Parameters		Neonate (<30 days)	Infant (>30 days)	p
n (%)		22 (53.7)	19 (46.3)
Age (days)^* * Mann-Whitney U test;		20.86±9.69	112.89±47.53	<0.001
Weight (kg)^* * Mann-Whitney U test;		3.33±0.57	5.32±1.28	<0.001
Gender n (%)^ Fisher's exact test;				0.436
	Male	19 (86.4)	14 (73.7)
	Female	3 (13.6)	5 (26.3)
Genetic anomaly (%)				0.321
	Yes	21 (95.5)	16 (84.2)
	No	1 (4.5)	3 (15.8)
Prematurity n (%)^* ***** Chi-square test.				0.524
	No	17 (77.3)	13 (68.4)
	Yes	5 (22.7)	6 (31.6)
Preoperative cardiac Z scores
	Aortic annulus Z score^* * Mann-Whitney U test;	-1.99±1.50	-1.22±2.12	0.284
	Proximal arc Z score^* * Mann-Whitney U test;	-3.94±1.49	-2.99±1.42	0.029
	Distal arc Z score^* * Mann-Whitney U test;	-3.91±1.73	-3.43±1.51	0.472
	Istmus Z score^* * Mann-Whitney U test;	-4.68±2.52	-3.39±1.52	0.094
Hypoplastic arcus n (%)^ Fisher's exact test;				0.080
	No	1 (4.5)	5 (26.3)
	Yes	21 (95.5)	14 (73.7)
Length of stay at intensive care unit (days)^* * Mann-Whitney U test;		2.55±0.69	2.14±0.97	0.013
Total length of hospitalization (days)^* * Mann-Whitney U test;		14.23±5.03	11.24±6.34	0.017
Mortality n (%)^* * Mann-Whitney U test;				0.610
	No	19 (86.4)	18 (94.7)
	Yes	3 (13.6)	1 (5.3)
Postoperative re-intervention requirement n (%)^* * Mann-Whitney U test;				0.610
	No	19 (86.4)	18 (94.7)
	Yes	3 (13.6)	1 (5.3)

Neonate		ALSG and postoperative early systolic max echo gradient (mm Hg)^* * Fisher's exact test. ALSG: arm-leg blood pressure systolic gradient.		p
ALSG and preoperative Sistolik max echo gradient (mm Hg)^* * Fisher's exact test. ALSG: arm-leg blood pressure systolic gradient.		<20 mm Hg (n, %)	≥20 mm Hg (n, %)	<0.001
	< 20 mm Hg (n, %)	1 (5.0)	0 (0.0)
	≥ 20 mm Hg (n, %)	19 (95.0)	2 (100.0)
		ALSG and postoperative sixth-month systolic max echo gradient (mm Hg)^* * Fisher's exact test. ALSG: arm-leg blood pressure systolic gradient.		1.00
ALSG and postoperative early systolic max echo gradient (mm Hg)^* * Fisher's exact test. ALSG: arm-leg blood pressure systolic gradient.		<20 mm Hg (n, %)	≥20 mm Hg (n, %)
	<20 mm Hg (n, %)	19 (90.5)	1 (100.0)
	≥20 mm Hg (n, %)	2 (9.5)	0 (0.0)
Infant		ALSG and postoperative early systolic max echo gradient (mm Hg)^* * Fisher's exact test. ALSG: arm-leg blood pressure systolic gradient.		p
ALSG and preoperative systolic max echo gradient (mm Hg)^* * Fisher's exact test. ALSG: arm-leg blood pressure systolic gradient.		<20 mm Hg (n, %)	≥20 mm Hg (n, %)	<0.001
	<20 mm Hg (n, %)	1 (6.3)	0 (0.0)
	≥20 mm Hg (n, %)	15 (93.8)	3 (100.0)
		ALSG and postoperative sixth-month systolic max echo gradient (mm Hg)^* * Fisher's exact test. ALSG: arm-leg blood pressure systolic gradient.
ALSG and postoperative early systolic max echo gradient (mm Hg)^* * Fisher's exact test. ALSG: arm-leg blood pressure systolic gradient.		<20 mm Hg (n, %)	≥20 mm Hg (n, %)	1.00
	<20 mm Hg (n, %)	15 (88.2)	1 (50.0)
	≥20 mm Hg (n, %)	2 (11.8)	1 (50.0)

		Preoperative Z score	Postoperative sixth-month Z score	p
Neonate
	Aortic annulus	-1.99±1.50	-1.00±0.93	0.002
	Proximal arc	-3.94±1.49	-1.27±1.07	<0.001
	Distal arc	-3.91±1.73	-1.63±1.61	0.001
	Istmus	-4.68±2.52	-2.08±1.96	0.001
Infant
	Aortic annulus	-1.22±2.12	-0.26±1.10	0.094
	Proximal arc	-2.99±1.42	-1.04±1.09	<0.001
	Distal arc	-3.43±1.51	-0.53±1.21	<0.001
	Istmus	-3.39±1.52	-1.19±0.47	<0.001

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: mustafayz1983@gmail.com