Risk factors of mortality and recoarctation after coarctation repair in infancy

Abstract

The main challenge of aortic coarctation repair in infants is to obtain durable results without morbidity. We aimed to describe predictors of mortality and of arch aortic re-intervention after aortic coarctation repair. Between January 2000 and March 2014, we retrospectively included consecutive infants with isolated coarctation or coarctation with ventricular septal defect (CoA + VSD) who had surgical repair of the aortic arch before three months of age. Five hundred and thirty patients were included: 308 (58%) patients had isolated coarctation and 222 (42%) had CoA + VSD. Three hundred and eighty-five (72.6%) only had coarctation repair, 51 patients (9.6%) had coarctation repair with closure of VSD, and 94 patients (17.8%) had coarctation repair and pulmonary artery banding. Mean age at operation was 13 ± 1.6 days. Mean weight at repair was 3.2 ± 0.75 kg. Median follow-up was 7.57 [0.25–15.98] years. Sixty-one patients (11.5%) needed reintervention on the aortic arch (surgery or endovascular interventions). Freedom from aortic arch reintervention was 90% at one year, and 88.5% at five years. Rates of aortic arch reintervention were similar in the different surgical strategy groups ( P = 0.80). However, in patients receiving prostaglandin E1 (PGE1), the end-to-end repair was at higher risk of re-coarctation compared to the extended end-to-side repair ( P = 0.0081). The risk factors of aortic arch reintervention were age at repair < 15 days ( P = 0.032), and the need for PGE1 infusion at surgery ( P = 0.0072). Overall mortality was 3.6% (19 patients) without significant difference between surgical strategies ( P = 0.078). In multivariate analysis, the risk factors of death were the presence of VSD ( P = 0.037), and low weight at surgery ( P = 0.001). The use of PGE1 may modify the aortic arch anatomy and mask the boundaries of the resection to be performed. Strategies to improve the surgical strategy preoperatively should be developed.