Abstract
Aim. To compare immediate and long-term results of palliative stenting and surgical correction of critical aortic coarctation in newborns. Material and methods. A single-center retrospective study was conducted at Meshalkin National Medical Research Center. From 2008 to 2021, the Department of Congenital Heart Diseases performed surgical treatment of 85 patients with critical aortic coarctation. Excluded from the study 11 patients. All patients included in the study (n = 74) were divided into two groups: palliative stenting (n = 20; 27%) and primary surgery (n = 54; 73%). After PSM analysis, the groups were balanced by age, weight, gender, body surface area and lactate. 40 patients were selected: 20 people in each group. There are no significant differences in basic characteristics between the groups.
Results. The technical success of aortic coarctation stenting is 100%. The lethal outcome in the stenting group was in 2 (10%) cases, while in the primary surgery group it was in 11 (55.5%) cases, p = 0,048. Complications in the early postoperative period were higher in the open surgery group.
Long-term complications do not differ between groups and have an equal incidence of development.
Conclusions. Palliative stenting of critical aortic coarctation is accompanied by lower mortality in the hospital period compared with primary surgical correction (10% vs 55.5%, p = 0.048). Multiple organ failure in the early postoperative period is an independent risk factor (hazard ratio (HR) 102; 95% confidence interval (CI) 3.5–295, p < 0.01) of death.
Patients with critical aortic coarctation after primary surgical correction have a higher incidence of early postoperative complications in comparison with palliative stenting (80% vs 40%, p = 0.02).
The only risk factor for multiple organ failure (HR 22.8; 95% CI 4.1–302.0, p = 0.03) and/or acute renal failure (HR 17.6; 95% CI 1.3–238.0, p = 0.02) is primary surgical correction of the defect. The main risk factor for abdominal syndrome are patients operated under conditions of artificial circulation (HR 19; 95% CI 4.8–280.0, p = 0.01).
Long-term complications do not differ between groups and have an equal frequency of occurrence.
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About the authors
- Kseniya A. Rzaeva, Postgraduate, Doctor for X-ray Endovascular Diagnosis and Treatment; ORCID
- Ilya A. Soynov, Cand. Med. Sci., Cardiovascular Surgeon of the Department of Congenital Heart Defects; ORCID
- Aleksey N. Arkhipov, Cand. Med. Sci., Cardiovascular Surgeon of the Department of Congenital Heart Defects, Head of the Department of Congenital Heart Defects; ORCID
- Yuriy N. Gorbatykh, Dr. Med. Sci., Professor, Leading Researcher, Cardiovascular Surgeon of the Department of Congenital Heart Defects; ORCID
- Aleksandr V. Bogachev-Prokophiev, Dr. Med. Sci., Director of the Institute of Circulatory Pathology, Cardiovascular Surgeon; ORCID
