초록접수 현황
| 19F-223 | 구연 발표 |
Surgical Outcomes in Coarctation of Aorta with Infants Weighing Less Than 2.5 kg
Won Young Lee, Bo Sang Kwon, Eun Seok Choi, Chun Soo Park, Tae-Jin Yun
Division of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
Purpose : Left ventricular outflow tract obstruction (LVOTO) is a critical consideration in aortic coarctation (CoA) repair, especially when patients weigh less than 2.5kg. We performed a retrospective study to evaluate the surgical outcomes after the surgical repair of aortic CoA repair in infants weighing less than 2.5 kg.
Methods : Between 2003 and 2018, 48 neonates (female 28, 58.3%) less than 2.5 kg underwent CoA repair. Patients with isolated CoA or CoA associated with VSD were included, and CoA associated with hypoplastic left ventricle was excluded which single ventricle strategy was conducted. Peri-operative data were collected for risk analysis for mortality with anatomic details, especially to LVOTO (Z score≤-3) related surgical strategy. Pre-operative LVOTO were identified in 15 patients and nine patients underwent palliation strategy including four bilateral pulmonary artery banding (PAB) for staged Yasui operation, three DKS with bilateral PAB, and two coarctoplasty with PAB.
Results : During the follow-up period (median, 2.7 years), 16 mortality had occurred including 10 in-hospital death and six late mortality. In Cox regression analysis, prematurity (hazard ratio (HR): 5.53, p = 0.013), preoperative pulmonary hypertension (HR: 5.29, p = 0.01), and palliation strategy (HR: 5.60, p = 0.026) was identified as risk factors for mortality. LVOT Z-score was not associated to increased mortality.
Conclusion : Management in neonates with coarctation weighing less than 2.5 kg are still challenging with high mortality rate. However, appropriate strategy in critical situation might improve surgical outcomes. Also preoperative management in pulmonary hypertension and planned delivery after preterm period might improve postoperative outcomes.
Methods : Between 2003 and 2018, 48 neonates (female 28, 58.3%) less than 2.5 kg underwent CoA repair. Patients with isolated CoA or CoA associated with VSD were included, and CoA associated with hypoplastic left ventricle was excluded which single ventricle strategy was conducted. Peri-operative data were collected for risk analysis for mortality with anatomic details, especially to LVOTO (Z score≤-3) related surgical strategy. Pre-operative LVOTO were identified in 15 patients and nine patients underwent palliation strategy including four bilateral pulmonary artery banding (PAB) for staged Yasui operation, three DKS with bilateral PAB, and two coarctoplasty with PAB.
Results : During the follow-up period (median, 2.7 years), 16 mortality had occurred including 10 in-hospital death and six late mortality. In Cox regression analysis, prematurity (hazard ratio (HR): 5.53, p = 0.013), preoperative pulmonary hypertension (HR: 5.29, p = 0.01), and palliation strategy (HR: 5.60, p = 0.026) was identified as risk factors for mortality. LVOT Z-score was not associated to increased mortality.
Conclusion : Management in neonates with coarctation weighing less than 2.5 kg are still challenging with high mortality rate. However, appropriate strategy in critical situation might improve surgical outcomes. Also preoperative management in pulmonary hypertension and planned delivery after preterm period might improve postoperative outcomes.
첨부파일 : 초록 접수최종.pptx
책임저자: Tae-Jin Yun
Division of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
발표자: Won Young Lee, E-mail : william330@naver.com