Outcome after extended arch repair for aortic coarctation

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Thoracic Surgery

Background:

• Coarctation of the aorta is a critical congenital heart defect requiring surgical intervention.
• Extended arch repair techniques aim to improve outcomes for affected children.
• Long-term data on survival and arch patency after this repair are crucial.

Purpose of the Study:

• To evaluate survival and long-term aortic arch patency rates in pediatric patients following extended arch repair for coarctation of the aorta.
• To identify risk factors associated with adverse outcomes in this patient cohort.

Main Methods:

• A retrospective review of 191 children who underwent extended arch repair for coarctation of the aorta between 1990 and 2002.
• Patients were categorized into three groups based on associated cardiac anomalies: coarctation alone, coarctation with ventricular septal defect, and coarctation with complex intracardiac anomalies.
• Prospective clinical and echocardiographic evaluations were performed to assess arch patency.

Main Results:

• Overall actuarial survival rates were high: 92% at 2 years, 88% at 5 years, and 88% at 10 years.
• Mortality was significantly higher in patients with complex intracardiac anomalies.
• Recurrent arch obstruction occurred in 4.2% of patients, with a significantly higher rate in premature infants (30%) compared to term infants (2.9%).

Conclusions:

• Extended arch reconstruction for coarctation of the aorta demonstrates excellent survival rates in children.
• Long-term follow-up reveals a low incidence of recurrent arch obstruction.
• Prematurity emerged as the only significant risk factor for recurrent arch obstruction.