Bronchial Compression Following Surgical and Transcatheter Interventions for Coarctation of the Aorta

Bronchial compression (BC) can occur after surgical repair of coarctation of the aorta (CoA); however, its incidence after stent implantation is not well understood. This study investigates the incidence, risk factors, and mechanisms of BC in patients undergoing surgical repair and stent implantation for CoA.

A retrospective review of patients aged 0-25 years who underwent CoA procedures at Rady Children's Hospital (San Diego, CA) between January 2007 and November 2022 was performed. Patients with computed tomography were included. BC was defined as an affected bronchus measuring <80% of the contralateral bronchus. Patients were divided into 3 groups: (1) group A-stent implantation only; (2) group B-surgical repair only; and (3) group C-surgical repair followed by stent implantation.

Among 205 patients with CoA, 148 met the inclusion criteria. The cohort was 64% male, with a median age at diagnosis of 2 days (IQR 0-54); 18% had single ventricle physiology. Group A included 15 patients (10%), group B had 119 patients (80%), and group C had 14 patients (9%). Surgical patients were younger (median 16 days [IQR, 8-54]) than stent patients [median 1939 days [IQR, 1220-2538]) at the time of the first intervention. BC was observed in 39 (26%) patients. Ten had preprocedural BC; 3 worsened postprocedure. De novo BC incidence was 7% (1/15) in group A, 18% (22/119) in group B, and 43% (6/14) in group C. Three patients required additional BC interventions.

BC incidence in CoA patients is increased and can be exacerbated by procedures. Although most patients with BC did not require intervention, considering preprocedural and postprocedural BC monitoring is recommended for timely diagnosis and management.