Coarctation of the aorta and aortic arch hypoplasia are treated with different surgical approaches.
Thoracotomy and Coarctectomy
A procedure called a lateral thoracotomy is a common approach for an uncomplicated case of coarctation. Compared with traditional open-heart surgery, a thoracotomy is less invasive for two main reasons. First, it does not require the use of a heart-lung bypass machine. Second, surgeons remove the narrowed portion of the aorta (this is called a coarctectomy) through a small incision on the side of the chest between the ribs, instead of through the breastbone. Then they use special stitching techniques to rejoin the two ends of the blood vessel and reduce the risk of future narrowing.
A sternotomy is usually recommended to repair aortic arch hypoplasia. This open-heart surgery requires separating the sternum (or breastbone) to access the heart. Pediatric heart surgeons remove or open the narrowed segment of the aorta, then use a patch to create a new aortic arch that allows better blood flow.
If your child requires a sternotomy, they may benefit from an advanced method called Sustained Total All-Region (STAR) perfusion. This technique, developed at Duke, keeps the heart beating, does not require lowering the patient’s body temperature, and maintains blood flow to all organs throughout the surgery. In addition to providing surgeons with real-time feedback about the heart’s function during the procedure, STAR perfusion has been shown to reduce bleeding after surgery and speed recovery.
During this minimally invasive procedure, an interventional cardiologist makes a small incision in the groin, inserts a thin, flexible tube called a catheter into a blood vessel, and guides it to the narrowed part of the aorta. Then a small balloon on the end of the catheter is inflated to expand the area. In some cases, a mesh metal tube called a stent is left behind to keep the aorta open.
Endovascular repair is best for children who are unable to undergo surgery or older patients with a repeat coarct.
Even after repairing the coarct surgically, your child may still have high blood pressure and need anti-hypertensive medication. Your doctor will recommend regular follow-up appointments to monitor blood pressure and check for signs of a repeat coarct.