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Long-Term Surgical Outcomes for Coarctation of the Aorta: A 15-Year Single-Center Experience
Ilya A Soynov1,2, Igor A Kornilov3, Artem V Gorbatykh4
1Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia.
Insights
Surgical repair of coarctation of the aorta in infants shows low mortality. Choosing median sternotomy with native tissue reduces recoarctation risk, while aortic arch shape impacts long-term outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Coarctation of the aorta (CoA) is a critical congenital heart defect requiring surgical intervention in infancy.
- Long-term outcomes after neonatal and infant CoA repair are crucial for patient management.
- Understanding predictors of mortality, recoarctation, and hypertension is essential for improving surgical strategies.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of surgical repair for coarctation of the aorta in neonates and infants.
- To identify predictors of mortality, recoarctation, and postoperative arterial hypertension.
- To assess the impact of surgical strategy on recoarctation risk and long-term complications.
Main Methods:
- Retrospective analysis of 308 infants (<12 months) undergoing primary coarctation of the aorta repair between 2008 and 2023.
- Assessment of overall mortality, recoarctation rates, and postoperative arterial hypertension.
- Statistical analysis to identify independent predictors of adverse outcomes, including surgical approach and aortic arch morphology.
Main Results:
- Overall mortality was 3.9%, with critical coarctation being the sole predictor of death.
- Recoarctation occurred in 8.1% of patients; predictors included low body weight, lateral thoracotomy, arch remodeling, and absorbable sutures.
- Postoperative hypertension was observed in 20.4%, with Gothic arch morphology and elevated left ventricular mass index (LVMI > 59 g/m²) as independent predictors.
Conclusions:
- Surgical strategy significantly influences the risk of recoarctation; median sternotomy using native tissue is associated with lower risk.
- Aortic arch shape is a predictor of long-term complications, with Romanesque-type arches linked to lower recoarctation risk and Gothic-type arches to higher hypertension risk.
- Elevated LVMI is the strongest predictor of arterial hypertension following coarctation repair.
Abstract:
Objective: To evaluate long-term outcomes following surgical repair of coarctation of the aorta (CoA) in neonates and infants. Materials and Methods: We assessed the operative results in 308 infants with CoA who underwent primary repair at our institute between 2008 and 2023. All of the patients were <12 months of age when they had their operation. Results: The overall mortality rate was 3.9% (12/308), with critical CoA identified as the only independent predictor of death. Recoarctation occurred in 8.1% (25/308) of patients, and the significant predictors of recoarctation included low body weight at the time of surgery, use of the lateral thoracotomy approach, aortic arch remodeling, and the use of absorbable sutures. Postoperative arterial hypertension was observed in 20.4% (63/308) of cases. Independent predictors of hypertension included gothic arch morphology and a left ventricular mass index (LVMI) greater than 59 g/m². Conclusions: The choice of surgical strategy significantly affects the risk for development of recoarctation. Median sternotomy with the use of native tissue for anastomosis reduces the risk of recoarctation. The shape of the aortic arch is a predictor of long-term complications. Lowering the risk of recoarctation is the Romanesque-type aortic arch and increasing the risk of arterial hypertension is the Gothic-type arch. The strongest predictor for arterial hypertension was a LVMI greater than 59 g/m².
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