The Society of Thoracic Surgeons Clinical Practice Guidelines on the Management of Neonates and Infants With Coarctation.
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2024-09
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Abstract
Background
Although coarctation of the aorta without concomitant intracardiac pathology is relatively common, there is lack of guidance regarding aspects of its management in neonates and infants.Methods
A panel of experienced congenital cardiac surgeons, cardiologists, and intensivists was created, and key questions related to the management of isolated coarctation in neonates and infants were formed using the PICO (Patients/Population, Intervention, Comparison/Control, Outcome) Framework. A literature search was then performed for each question. Practice guidelines were developed with classification of recommendation and level of evidence using a modified Delphi method.Results
For neonates and infants with isolated coarctation, surgery is indicated in the absence of obvious surgical contraindications. For patients with risk factors for surgery, medical management before intervention is reasonable. For those stable off prostaglandin E1, the threshold for intervention remains unclear. Thoracotomy is indicated when arch hypoplasia is not present. Sternotomy is preferable when arch hypoplasia is present that cannot be adequately addressed through a thoracotomy. Sternotomy may also be considered in the presence of a bovine aortic arch. Antegrade cerebral perfusion may be reasonable when the repair is performed through a sternotomy. Extended end-to-end, arch advancement, and patch augmentation are all reasonable techniques.Conclusions
Surgery remains the standard of care for the management of isolated coarctation in neonates and infants. Depending on degree and location, arch hypoplasia may require a sternotomy approach as opposed to a thoracotomy approach. Significant opportunities remain to better delineate management in these patients.Type
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Stephens, Elizabeth H, Eric N Feins, Tara Karamlou, Brett R Anderson, Bahaaldin Alsoufi, Mark S Bleiweis, Yves d'Udekem, Jennifer S Nelson, et al. (2024). The Society of Thoracic Surgeons Clinical Practice Guidelines on the Management of Neonates and Infants With Coarctation. The Annals of thoracic surgery, 118(3). pp. 527–544. 10.1016/j.athoracsur.2024.04.012 Retrieved from https://hdl.handle.net/10161/34243.
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Bradley Marino
Joseph W Turek
Joseph W. Turek, MD, PhD, MBA is an academic pediatric cardiac surgeon at Duke University in Durham, North Carolina. Since 2017, Dr. Turek has served as chief of pediatric cardiac surgery. Prior to Duke, he served in a similar leadership role at the University of Iowa Stead Family Children’s Hospital from 2012-2017.
Dr. Turek attended the Illinois Mathematics and Science Academy for secondary education. He then graduated from Northwestern University with a degree in biochemistry and received his MD/PhD (pharmacology) from the University of Illinois in Chicago with Alpha Omega Alpha distinction. He completed his general surgery education at Duke University, where he also finished a cardiothoracic surgery residency. During this time, he served as a visiting congenital heart surgery fellow at Texas Children’s Hospital. Dr. Turek completed a congenital cardiac surgery fellowship at the Children’s Hospital of Philadelphia in 2011. He received his MBA with a concentration in Health Sector Management from Duke’s Fuqua School of Business in 2020.
Board certified in general surgery, thoracic surgery and congenital cardiac surgery, Dr. Turek has been one of the foremost innovators of the last decade in congenital heart surgery, developing novel operations, modifying techniques and introducing new products and procedures to children and adults with congenital cardiac disease. Most notably, he performed the world’s first co-transplant of a heart and cultured thymus tissue, in an operation that could usher in an era in which solid organ transplant recipients can develop tolerance to their newly transplanted organ, recognizing them as “self”. In another highly innovative operation, he performed the world’s first partial heart transplant for a newborn without functioning aortic or pulmonary valves, maintaining growth capacity of the newly implanted valves. Additionally, he led the team at Duke in completing the nation’s first pediatric donation after circulatory death heart transplant with ex vivo reanimation and with normothermic regional perfusion, as a means to expand the already limited donor pool of available organs. His clinical passion and expertise lies in high complexity neonatal heart surgery.
Academically, Dr. Turek has published over 200 peer-reviewed manuscripts and numerous book chapters. He maintains an active and well-funded research laboratory with projects spanning from basic science to translational to clinical research, in areas such as heart transplant tolerance with thymus-heart co-transplant, partial heart transplantation, xenotransplantation, Marfan syndrome, and the role of alpha-gal sensitization in biologic valve degradation. He maintains active leadership roles in national and international cardiothoracic surgery societies.
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