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Soynov I.A.

Meshalkin National Medical Research Center

Rzaeva K.A.

Meshalkin National Medical Research Center

Gorbatykh Yu.N.

Meshalkin National Medical Research Center

Kulyabin Yu.Yu.

Meshalkin National Medical Research Center

Gorbatykh A.V.

Almazov National Medical Research Center

Velyukhanov I.A.

Meshalkin National Medical Research Center

Nichay N.R.

Meshalkin National Medical Research Center

Manukyan S.N.

Meshalkin National Medical Research Center

Magbulova S.A.

Meshalkin National Medical Research Center

Arkhipov A.N.

Meshalkin National Medical Research Center

Journal: Russian Journal of Cardiology and Cardiovascular Surgery. 2024;17(4): 370–380

Does surgical access affect postoperative outcomes in patients with aortic coarctation?

Authors:

Soynov I.A., Rzaeva K.A., Gorbatykh Yu.N., Kulyabin Yu.Yu., Gorbatykh A.V., Velyukhanov I.A., Nichay N.R., Manukyan S.N., Magbulova S.A., Arkhipov A.N.

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DOI: 10.17116/kardio202417041370

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OBJECTIVE

To compare two surgical approaches: sternotomy and left-sided thoracotomy in patients with aortic coarctation and hypoplasia of the distal aortic arch.

MATERIAL AND METHODS

A single-center retrospective study was conducted at the Meshalkin National Medical Research Center. There were 489 surgeries for aortic coarctation between January 2008 and December 2020. Of these, 103 (21%) procedures implied oblique expanded anastomosis suitable for inclusion criteria.

RESULTS

Mortality rate was 4% (n=1) and 8% (n=2) after lateral thoracotomy and sternotomy, respectively (p>0.99). Duration of early postoperative inotropic support and Z score of distal aortic arch were higher in the sternotomy group.

CONCLUSION

Aortic arch remodeling (gothic and embrasure form) did not differ between sternotomy and thoracotomy in the treatment of aortic coarctation with hypoplasia of distal aortic arch. However, redo coarctation was more common after thoracotomy (20.8% vs. 0%). ROC analysis found that weight affects compression of bronchi or trachea (AUC 0.08, 95% CI 0.01; 0.19). The «cut-point» was 2.5 kg with sensitivity 70% and specificity 72% (p=0.048). There were no deaths in long-term period. Mean follow-up period was 36 (31; 40) months.

Keywords:

lateral thoracotomy
sternotomy
aortic arch remodeling

Authors:

Soynov I.A.

Meshalkin National Medical Research Center

Rzaeva K.A.

Meshalkin National Medical Research Center

Gorbatykh Yu.N.

Meshalkin National Medical Research Center

Kulyabin Yu.Yu.

Meshalkin National Medical Research Center

Gorbatykh A.V.

Almazov National Medical Research Center

Velyukhanov I.A.

Meshalkin National Medical Research Center

Nichay N.R.

Meshalkin National Medical Research Center

Manukyan S.N.

Meshalkin National Medical Research Center

Magbulova S.A.

Meshalkin National Medical Research Center

Arkhipov A.N.

Meshalkin National Medical Research Center

Received:

19.09.2023

Accepted:

09.10.2023

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