Operative risk factors and durability of repair of coarctation of the aorta in the neonate

Abstract

The risk factors for the operative mortality and long-term durability of repair after surgical correction of coarctation of the aorta in neonates remain controversial. Between January 1970 and January 1993, 139 patients under 1 month of age underwent repair of coarctation of the aorta. Complex intracardiac defects were present in 59 patients. Another 44 patients had an associated ventricular septal defect Subclavian artery flap repair was performed in 92 patients; end-to-end anastomosis (38 patients) and patch angioplasty (9 patients) were performed less commonly. The hospital mortality was significantly higher in patients with complex intracardiac defects (9 of 59 patients; 15.2%) than in those with a ventricular septal defect (1 of 44 patients; 2.3%) or with isolated coarctation (none of 36 patients; p = 0.007). Elevated pulmonary artery diastolic pressure ( p = 0.041) and complex intracardiac anomalies ( p = 0.048) were found to be independent predictors of hospital mortality. The presence of a complex cardiac defect ( p < 0.001) was an independent predictor of poor long-term survival. Recurrent stenosis requiring reoperation had occurred or balloon dilation had been necessary in 27.9% of the children at 5 years postoperatively. In patients followed up for at least 5 years, the recurrence-free survival was better in those who had undergone subclavian artery flap repair than in those who had undergone end-to-end repair ( p = 0.017). When coarctation of the aorta must be repaired in the neonate, operative mortality and long-term survival are affected by the complexity of associated intracardiac anomalies. The subclavian artery flap repair of aortic coarctation in neonates was found to result in a lower rate of recurrent stenosis in patients followed up for at least 5 years postoperatively.