Abstract 18989: Neonatal Arch Reconstruction via Sternotomy or Thoracotomy: A Propensity Score Matched Analysis

Abstract

Introduction: For neonatal repair of coarctation of the aorta, patients may either undergo thoracotomy or sternotomy with cardiopulmonary bypass. While some guidance exists, the optimal approach remains poorly defined. Methods: This is a single center retrospective cohort study from 7/05 through 5/22 including patients who underwent neonatal aortic arch reconstruction for isolated coarctation of the aorta and excluding genetic syndromes, heterotaxy, and right aortic arch. Propensity score was estimated using demographic and anatomic variables and 1:1 optimal matching was performed. Primary outcomes were reintervention, either open or catheter-based, and survival. A hazard spline was constructed in order to assess the effect of varying distal arch size on hazard of reoperation (Figure 1). ICU and Hospital length of stay were secondary outcomes. Results: There were 263 patients who underwent isolated coarctation repair during the given time period. Matching yielded 50 patient pairs (n = 100). In the propensity matched population, one patient died and 11 patients underwent reintervention, with 2 of these patients undergoing 2 reinterventions. The interaction between distal transverse arch size and operative approach (sternotomy vs. thoracotomy) was statistically significant, p < 0.05 for interaction. Among patients with a distal arch z-score < -3.5, there appeared to be an advantage to sternotomy. With a distal arch z-score > -3.5, patients undergoing sternotomy appeared to have a disadvantage with respect to risk for reintervention. ICU length of stay was greater for patients undergoing sternotomy, 5.9 days [IQR: 4 to 12.6] vs 2.8 days [IQR: 1.7 to 4.2], p < 0.001, as was hospital length of stay, 14.3 days [IQR: 11 to 23.7] vs 6.5 days [IQR: 5.2 to 9.8], p < 0.001. Conclusions: Patients with a distal arch z-score larger than -3.5 may benefit from thoracotomy, and those with a distal arch z-score smaller than -3.5 may benefit from sternotomy.