Aortic arch advancement: the optimal one-stage approach for surgical management of neonatal coarctation with arch hypoplasia

Background. The optimal surgical treatment for neonatal coarctation with aortic arch hypoplasia (NCoAo/AAH) is controversial. Important long-term concerns include arch growth. We report our results obtained with a one-stage radical approach of coarctectomy and aortic arch advancement for NCoAo/AAH. Methods. From June 1995 to December 2000, 65 newborns with NcoAo/AAH underwent coarctectomy and aortic arch advancement via a median sternotomy under deep hypothermic circulatory arrest. Patients were classified by diagnosis: group 1, isolated NCoAo/AAH (n = 13); group 2, NCoAo/AAH with ventricular septal defect (n = 20); and group 3, NCoAo/AAH with complex cardiac lesions (n = 32). Results. The study population included 36 boys and 29 girls. Mean age was 13 ± 1.7 days (range 1 to 43 days). Mild to moderate left ventricular outflow tract obstruction was present in 15 patients. Mean body weight was 3.4 ± 0.1 kg (range 1.6 to 5 kg). Eight babies were premature. The mean Z value for the aortic arch was −4 ± 0.3 (range −2 to −4.5) and for the isthmus −4.5 ± 0.2 (range −3 to −7). Mean deep hypothermic circulatory arrest time was 28 ± 2 minutes (range 14 to 60 minutes). Mean intensive care unit stay was 6 ± 1 days (range 2 to 30 days). There were three early deaths (all in groups 2 and 3) and two late deaths (in group 3) (5-year actuarial survival, 91% ± 7.9%). There was one recurrence (5-year actuarial freedom from recurrence, 98% ± 4%). Peak Doppler velocity across the arch in the remaining patients was 1 ± 0.1 m/s (range 0 to 2.2 m/s). Conclusions. Coarctectomy and aortic arch advancement is the optimal surgical method for management of NCoAo/AAH. It has low operative morbidity and mortality and a very low incidence of recoarctation or arch obstruction.