Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery

Abstract

BackgroundIn neonates with critical aortic coarctation (CoA) primary stenting of CoA may serve as therapeutic bridging until definitive surgical repair. MethodsComparative study of acute and long-term outcome of neonates with critical CoA treated by combined stent-surgery approach, or by primary surgery. Complications, re-intervention rate, clinical and echocardiographic findings of left ventricular (LV) function were compared. ResultsBetween 2012 and 2014, we treated 20 neonates at a median age of 9 (7–51) days and a body weight of 3.6 (3–4.1) kg. We compared 10 neonates treated by primary CoA stenting and secondary surgery with stent removal and CoA repair with 10 age-matched infants with primary surgical CoA repair. There was no early or late mortality. Perioperative complications and rate of re-intervention were comparable in both groups. LV function was reduced before first intervention ejection fraction (EF) 39% (30–42), shortening fraction 27% (20–32), more affected in the stent group, but recovered after stenting until secondary surgery (EF 30% vs. EF 40%, p = 0.01) and normalized until last follow-up (EF 62%, p < 0.01) resp. after primary repair until discharge (EF 60%, p < 0.01). At last follow-up, at an age of 5.2 (4.8–5.9) years, all children were asymptomatic (NYHA 1), without arterial hypertension, or cardiac medication, and with normal LV function and LV mass. ConclusionsThe combined stent-surgery approach for critical CoA is an alternative treatment leading to comparable acute and long-term results. It allows LV remodelling before secondary corrective surgery with stent removal via a regular left lateral approach under cross-clamping the aortic arch.