Bovine Arch Anatomy Influences Recoarctation Rates in the Era of the Extended End-to-End Anastomos
PúblicoMLA citation style (9th ed.)
. 1192. marian.palni-palci-staging.notch8.cloud/concern/generic_works/d14eb4ad-e1ce-4d24-99f0-f4835bb99fee?locale=es. Bovine Arch Anatomy Influences Recoarctation Rates In the Era of the Extended End-to-end Anastomos.APA citation style (7th ed.)
(1192). Bovine Arch Anatomy Influences Recoarctation Rates in the Era of the Extended End-to-End Anastomos. https://marian.palni-palci-staging.notch8.cloud/concern/generic_works/d14eb4ad-e1ce-4d24-99f0-f4835bb99fee?locale=esChicago citation style (CMOS 17, author-date)
Bovine Arch Anatomy Influences Recoarctation Rates In the Era of the Extended End-To-End Anastomos. 1192. https://marian.palni-palci-staging.notch8.cloud/concern/generic_works/d14eb4ad-e1ce-4d24-99f0-f4835bb99fee?locale=es.Note: These citations are programmatically generated and may be incomplete.
Objectives: Arch branching has never been shown to influence recoarctation after extended end-to-end anastomosis via thoracotomy, yet in each study bovine arch identification is grossly underreported. This study aims to: 1) assess chart review reliability in bovine arch identification, 2) determine recoarctation risk with a bovine arch, and 3) explore an anatomic explanation for recurrent arch obstruction based on arch anatomy. Patients and Methods: 49 consecutive patients underwent thoracotomy with extended end-to-end aortic coarctation repair at a single institution (2007-2012). Echocardiograms from these patients were reviewed for arch anatomy and compared to the echocardiographic reports. Recurrent arch obstruction was defined as an echocardiographic gradient across the repair ≥20 mmHg. For cases with angiographic images, a scaled clamping distance between the left subclavian artery and the maximal proximal clamp location on orthogonal projections was then calculated across arch anatomies. Results: Chart review identified 6.1% of patients with a bovine arch, compared to 28.6% on targeted image review. 28.6% of bovine arch patients had a follow-up gradient ≥20mmHg. Only 5.7% of normal arch branching patients had a follow-up gradient ≥20mmHg. The mean clamping index was significantly diminished in patients with bovine arch anatomy. Conclusions: Arch anatomy often goes undocumented on preoperative imaging, yet children undergoing extended end-to-end repair with bovine arch anatomy are at a significantly increased risk of recoarctation. This may be due to a reduced clampable distance to facilitate repair. These results should trigger a profound paradigm shift in preoperative assessment, parental counseling and surgical approach for children with discrete aortic coarctation. Objectives: Arch branching has never been shown to influence recoarctation after extended end-to-end anastomosis via thoracotomy, yet in each study bovine arch identification is grossly underreported. This study aims to: 1) assess chart review reliability in bovine arch identification, 2) determine recoarctation risk with a bovine arch, and 3) explore an anatomic explanation for recurrent arch obstruction based on arch anatomy. Patients and Methods: 49 consecutive patients underwent thoracotomy with extended end-to-end aortic coarctation repair at a single institution (2007-2012). Echocardiograms from these patients were reviewed for arch anatomy and compared to the echocardiographic reports. Recurrent arch obstruction was defined as an echocardiographic gradient across the repair ≥20 mmHg. For cases with angiographic images, a scaled clamping distance between the left subclavian artery and the maximal proximal clamp location on orthogonal projections was then calculated across arch anatomies. Results: Chart review identified 6.1% of patients with a bovine arch, compared to 28.6% on targeted image review. 28.6% of bovine arch patients had a follow-up gradient ≥20mmHg. Only 5.7% of normal arch branching patients had a follow-up gradient ≥20mmHg. The mean clamping index was significantly diminished in patients with bovine arch anatomy. Conclusions: Arch anatomy often goes undocumented on preoperative imaging, yet children undergoing extended end-to-end repair with bovine arch anatomy are at a significantly increased risk of recoarctation. This may be due to a reduced clampable distance to facilitate repair. These results should trigger a profound paradigm shift in preoperative assessment, parental counseling and surgical approach for children with discrete aortic coarctation. Objectives: Arch branching has never been shown to influence recoarctation after extended end-to-end anastomosis via thoracotomy, yet in each study bovine arch identification is grossly underreported. This study aims to: 1) assess chart review reliability in bovine arch identification, 2) determine recoarctation risk with a bovine arch, and 3) explore an anatomic explanation for recurrent arch obstruction based on arch anatomy. Patients and Methods: 49 consecutive patients underwent thoracotomy with extended end-to-end aortic coarctation repair at a single institution (2007-2012). Echocardiograms from these patients were reviewed for arch anatomy and compared to the echocardiographic reports. Recurrent arch obstruction was defined as an echocardiographic gradient across the repair ≥20 mmHg. For cases with angiographic images, a scaled clamping distance between the left subclavian artery and the maximal proximal clamp location on orthogonal projections was then calculated across arch anatomies. Results: Chart review identified 6.1% of patients with a bovine arch, compared to 28.6% on targeted image review. 28.6% of bovine arch patients had a follow-up gradient ≥20mmHg. Only 5.7% of normal arch branching patients had a follow-up gradient ≥20mmHg. The mean clamping index was significantly diminished in patients with bovine arch anatomy. Conclusions: Arch anatomy often goes undocumented on preoperative imaging, yet children undergoing extended end-to-end repair with bovine arch anatomy are at a significantly increased risk of recoarctation. This may be due to a reduced clampable distance to facilitate repair. These results should trigger a profound paradigm shift in preoperative assessment, parental counseling and surgical approach for children with discrete aortic coarctation.
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Bovine_Arch_Cavanaugh_2018.pdf | 2021-05-05 | Público | Descargar |