Risk Factors for Recoarctation and Mortality in Infants Submitted to Aortic Coarctation Repair: A Systematic Review.

Margarida Q. Dias,Adelino Leite-Moreira,Joana O. Miranda,António Barros

doi:10.1007/s00246-020-02319-w

Margarida Q. Dias, Adelino Leite-Moreira + Show 2 more

Open Access

https://doi.org/10.1007/s00246-020-02319-w

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Abstract

Aortic coarctation is a common congenital heart defect that often requires correction at a young age. Currently, success is defined by the achievement of a durable repair with low morbidity and mortality. We sought to systematically review the literature on risk factors for recoarctation and mortality in infants submitted to aortic arch coarctation repair under 1year of age. PubMed and Scopus were searched for studies reporting risk factors for recoarctation and mortality from January 1989 to August 2019. Among the 1038 retrieved articles, 18 met the inclusion criteria, with a total of 2891 patients. The extracted risk factors for recoarctation were comprehensively summarized in the following categories: demographicvariables, associated anomalies, clinical and repair variables, and morphometric variables. Younger age and lower weight were weak determinants of need for reintervention, while smaller aortic arch was a strong predictor of recoarctation. While balloon angioplasty is a clear risk factor for arch restenosis, the chosen surgical technique is not a strong risk factor. Associated minor cardiac anomalies and lower weight at surgery were important risk factors for death. Younger and smaller infants are at increased risk for adverse outcomes when submitted to aortic arch coarctation repair. This is particularly important when associated with smaller arch morphology. Strategies to improve the management of these patients may play a key role in improving their outcomes. Notably, surgical technique was not a strong predictor of recoarctation and mortality, suggesting that the choice of one over the other should be tailored.

Highlights

Coarctation of the aorta is a common congenital heart defect typically characterized by narrowing of the aortic isthmus near the ductus arteriosus
The present systematic review was based mainly on observational studies and explored the risk factors for recoarctation and mortality in infants submitted to repair of coarctation of the aorta under 1 year of age
These findings suggest that age at repair may not be a strong determinant of recoarctation or death as previously assumed

Summary

Introduction

Coarctation of the aorta is a common congenital heart defect typically characterized by narrowing of the aortic isthmus near the ductus arteriosus It can range from a discrete coarctation to a long segment of arch hypoplasia[1]. In young patients with native aortic coarctation not associated with other major cardiac defects, end-to-end anastomosis and extended end-to-end anastomosis are the most frequently used techniques[3]. We sought to systematically review the literature on risk factors for recoarctation and mortality in infants submitted to aortic arch coarctation repair under 1 year of age. Conclusion: Younger and smaller infants are at increased risk for adverse outcomes when submitted to aortic arch coarctation repair. This is important when associated with smaller arch morphology. Surgical technique was not a strong predictor of recoarctation and mortality, suggesting that the choice of one over the other should be tailored

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