Incidence of re-coarctation of the aorta after surgical correction in neonates; a single centre experience

Aims: Surgical management of patients with coactation of the aorta (CoA) has advanced over the last decades. Definitive early surgical repair for CoA has become the treatment of the choice at many centres.

Methods: From 1998 through 2010, 57 neonates underwent surgical repair of coarctation of the aorta with extended end-to-side anastomosis. A retrospective analysis of the cardiac surgery database was performed to collect preoperative dimensions of aortic segments. Blood pressure gradients between arms and legs determined by cuff were compared intraoperatively and postoperatively, as well as 2-dimensional echocardiographic dimensions of the aorta between those who did not require reintervention for recoarctation (group A) and those who did (group B).

Results: The study population included 37 males and 20 females younger than 28 days. Mean age was 11 ± 8 days (range, 1 to 28 days). The mean weight was 3 ± 0.7 kg (range, 1.8 to 4.6 kg). Surgical approach was by left thoracotomy in all patients with a mean cross-clamp time of 12 ± 14 minutes. There was no perioperative or in-hospital mortality and 2 late deaths. Mean follow-up time was 6.1 ± 5.6 years. At latest follow-up, the mean peak gradient was 24 ± 23 mmHg. Recoarctation developed in 7 patients (12%), defined as a resting blood pressure gradient of greater than 20 mm Hg. All 7 patients received balloon angioplasties. In 1 patient additional reoperation was necessary. Multivariable logistic regression analysis identified the size of the ascending aorta as a risk factor for recoarctation. Blood pressure gradient at the end of surgery was not predictive of recoarctation.

Conclusion: Resection with extended end-to-side anastomosis yields a low mortality and particularly an acceptable recoarctation rate and is our procedure of choice for infants with coarctation of the aorta without using any foreign material or flap. Small size of the ascending aorta is a risk factor for recoarctation. Limb gradient in the operating room at completion of surgery is not a reliable tool to assess repair of coarctation, although the gradient at the time of hospital discharge can be used to accurately predict recoarctation.