[Safety of surgical therapy for neonate aortic coarctation combined with ventricular septal defect]

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2016 Jul;41(7):696-9. doi: 10.11817/j.issn.1672-7347.2016.07.006.
[Article in Chinese]

Abstract

Objective: To evaluate the safety of surgical repair for neonatal aortic coarctation combined with ventricular septal defect.

Methods: Twenty-three aortic coarctation neonates received surgical treatment and their clinical data between April, 2013 and May, 2015 were analyzed retrospectively. All patients underwent coarctation repair + ventricular septal defect repair and mild hyperthermia cardiopulmonary bypass under the condition of general anesthesia. All patients were subjected to delayed sternal closure.

Results: One patient died at early post-operation, and no one died during 2-27 months' follow-up. Operation time, cardiopulmonary bypass time, aortic cross-clamp time, ICU stay time, mechanical ventilation time, delayed sternal closure time, and post-operative hospital stay time were (192.7±43.4) min, (132.4±26.4) min, (65.3±18.4) min, (185.3±56.4) h, (42.4±24.5) h, (36.3±18.6) h, and (15.3±4.6) d, respectively. Post-operative complications presented in 12 patients, including post-operative hemorrhage in 6 patients, acute renal insufficiency in 4 patients, wound infection in 1 patient, and post-operative coarctation of the aorta in 1 patient.

Conclusion: One-stage complete repair for severe aortic coarctation combined with ventricular septal defect in neonates is safe, and the outcomes are satisfied. Fully free of the aortic arch and individual aorta reconstruction are the keies to successful operation.

目的:评价新生儿主动脉缩窄合并室间隔缺损手术治疗的安全性及技术要点。方法:回顾性分析湖南省儿童医院2013年4月至2015年5月23例手术治疗的主动脉缩窄合并室间隔缺损新生儿的临床资料,全组患儿均在全身麻醉浅低温体外循环下行主动脉缩窄矫治和室间隔缺损修补术,所有患儿延迟关胸。结果:全组术后早期死亡1例,随访2~27个月,无再次手术及死亡病例。手术时间(192.7±43.4) min,体外循环时间(132.4±26.4) min,主动脉阻断时间(65.3±18.4) min。ICU停留时间(185.3±56.4) h,呼吸机辅助通气时间(42.4±24.5) h,延迟关胸时间(36.3±18.6) h,术后住院时间(15.3±4.6) d。术后并发症12例,包括术后出血6例,急性肾功能衰竭4例,伤口延迟愈合1例,迟发主动脉再缩窄1例。结论:对于病情严重的新生儿期主动脉缩窄合并室间隔缺损患儿行一期手术矫治安全有效。充分游离主动脉弓部和个体化的主动脉成形方式,是手术成功的关键。.

MeSH terms

  • Aorta
  • Aortic Coarctation*
  • Heart Septal Defects, Ventricular*
  • Humans
  • Infant, Newborn
  • Postoperative Complications
  • Postoperative Period
  • Retrospective Studies
  • Safety