Muscle-sparing aortic coarctation repairCentral MessagePerspective
Objective: Surgery for aortic coarctation repair provides excellent hemodynamic results but may be complicated by musculoskeletal issues. The purpose of the study was to determine the midterm results of a muscle-sparing surgical approach to aortic coarctation repair, with special emphasis on the rep...
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Elsevier
2020-09-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250720302261 |
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| author | Stephanie G. Berset, MD Hitendu Dave, MD Christian Balmer, MD Anna Nowacka Raymond Pfister, MD Patrick O. Myers, MD René Prêtre, MD |
| author_facet | Stephanie G. Berset, MD Hitendu Dave, MD Christian Balmer, MD Anna Nowacka Raymond Pfister, MD Patrick O. Myers, MD René Prêtre, MD |
| author_sort | Stephanie G. Berset, MD |
| collection | DOAJ |
| description | Objective: Surgery for aortic coarctation repair provides excellent hemodynamic results but may be complicated by musculoskeletal issues. The purpose of the study was to determine the midterm results of a muscle-sparing surgical approach to aortic coarctation repair, with special emphasis on the repair and on the musculoskeletal changes associated with a posterior thoracotomy. Methods: We included all children with aortic coarctation operated on with our minimally invasive approach between June 2002 and October 2004, with a follow-up of ≥4.5 years. Patients were assessed clinically and echocardiographically. The spine, left chest, and shoulder were assessed clinically and radiographically. Results: Thirty-one children were included. The age at operation ranged from 1 day to 15 months and weight ranged from 980 g to 10 kg. All patients underwent an extended end-to-end anastomosis coarctation repair through a minimal (n = 19) or total-muscle sparing (n = 12) or extrapleural (n = 18) approach. Five patients had an additional enlargement procedure on the aortic arch. 27 patients had no residual or recurrent gradient. Four patients exhibited restenosis, for which 1 underwent a percutaneous angioplasty and 2 underwent surgical reintervention. All patients were free of hypertension. One patient had borderline values. The musculoskeletal assessment was normal in all but 3 patients. Two patients who underwent other subsequent thoracic surgeries developed thoracogenic scoliosis of moderate severity. A third patient had a left winged scapula. No rib fusion or intercostal space enlargement was found. Conclusions: Compared with a conventional approach, our minimally invasive surgical approach led to excellent musculoskeletal outcomes without compromising the hemodynamic results. |
| format | Article |
| id | doaj-art-d98f765066b24e4ab97be76c7cc72ca5 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-d98f765066b24e4ab97be76c7cc72ca52025-08-20T04:01:57ZengElsevierJTCVS Techniques2666-25072020-09-01324925610.1016/j.xjtc.2020.05.005Muscle-sparing aortic coarctation repairCentral MessagePerspectiveStephanie G. Berset, MD0Hitendu Dave, MD1Christian Balmer, MD2Anna Nowacka3Raymond Pfister, MD4Patrick O. Myers, MD5René Prêtre, MD6Department of Internal Medicine, Vaud University Hospital, Lausanne, Switzerland; Stephanie G. Berset, Service de Médecine Interne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Vaud, Suisse.Department of Cardiology, Zurich University Children's Hospital, Zurich, SwitzerlandDepartment of Cardiology, Zurich University Children's Hospital, Zurich, SwitzerlandDepartment of Cardiovascular Surgery, Valais Hospital, Sion, SwitzerlandDepartment of Cardiovascular Surgery, Vaud University Hospital, Lausanne, SwitzerlandDepartment of Cardiovascular Surgery, Vaud University Hospital, Lausanne, SwitzerlandDepartment of Cardiovascular Surgery, Vaud University Hospital, Lausanne, Switzerland; Address for reprints: René Prêtre, Service de Chirurgie Cardiaque, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Vaud, Suisse.Objective: Surgery for aortic coarctation repair provides excellent hemodynamic results but may be complicated by musculoskeletal issues. The purpose of the study was to determine the midterm results of a muscle-sparing surgical approach to aortic coarctation repair, with special emphasis on the repair and on the musculoskeletal changes associated with a posterior thoracotomy. Methods: We included all children with aortic coarctation operated on with our minimally invasive approach between June 2002 and October 2004, with a follow-up of ≥4.5 years. Patients were assessed clinically and echocardiographically. The spine, left chest, and shoulder were assessed clinically and radiographically. Results: Thirty-one children were included. The age at operation ranged from 1 day to 15 months and weight ranged from 980 g to 10 kg. All patients underwent an extended end-to-end anastomosis coarctation repair through a minimal (n = 19) or total-muscle sparing (n = 12) or extrapleural (n = 18) approach. Five patients had an additional enlargement procedure on the aortic arch. 27 patients had no residual or recurrent gradient. Four patients exhibited restenosis, for which 1 underwent a percutaneous angioplasty and 2 underwent surgical reintervention. All patients were free of hypertension. One patient had borderline values. The musculoskeletal assessment was normal in all but 3 patients. Two patients who underwent other subsequent thoracic surgeries developed thoracogenic scoliosis of moderate severity. A third patient had a left winged scapula. No rib fusion or intercostal space enlargement was found. Conclusions: Compared with a conventional approach, our minimally invasive surgical approach led to excellent musculoskeletal outcomes without compromising the hemodynamic results.http://www.sciencedirect.com/science/article/pii/S2666250720302261coarctation of the aortamuscle-sparing approachchildren |
| spellingShingle | Stephanie G. Berset, MD Hitendu Dave, MD Christian Balmer, MD Anna Nowacka Raymond Pfister, MD Patrick O. Myers, MD René Prêtre, MD Muscle-sparing aortic coarctation repairCentral MessagePerspective JTCVS Techniques coarctation of the aorta muscle-sparing approach children |
| title | Muscle-sparing aortic coarctation repairCentral MessagePerspective |
| title_full | Muscle-sparing aortic coarctation repairCentral MessagePerspective |
| title_fullStr | Muscle-sparing aortic coarctation repairCentral MessagePerspective |
| title_full_unstemmed | Muscle-sparing aortic coarctation repairCentral MessagePerspective |
| title_short | Muscle-sparing aortic coarctation repairCentral MessagePerspective |
| title_sort | muscle sparing aortic coarctation repaircentral messageperspective |
| topic | coarctation of the aorta muscle-sparing approach children |
| url | http://www.sciencedirect.com/science/article/pii/S2666250720302261 |
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