Mortality and Restenosis Rate of Surgical Coarctation Repair in Infancy: A Study of 191 Patients

Abstract

Study Design: This is a retrospective cross-sectional study to analyze mortality and the rate of restenosis in the follow-up of patients after surgical repair of isolated aortic coarctation in infancy. Patients and Methods: From 1974 to 2003, 191 patients underwent surgical repair of aortic coarctation in infancy. Follow-up data of 2,432 patient-years were extracted from the clinical files of our outpatient department or from family practitioners. Results: Five patients died (total mortality 2.6%): 1 patient intraoperatively and 2 within 30 days after surgery (early mortality 1.6%). The other 2 patients died within 3 months. All deaths were contributed to patients that underwent surgery in the years up to 1981 and within the first 43 days of life. Of the surviving 186 patients, 31 had reintervention because of restenosis and another 11 patients had a noninvasive brachial-ankle systolic blood pressure gradient >20 mm Hg, suggesting current restenosis. Risk factors for death or restenosis were a hypoplastic aortic arch and a low body length at surgery. Conclusions: Nowadays, surgical repair of coarctation can be performed in infancy with minimal risk. The restenosis rate is considerably high (23%). It is mainly caused by the size of the whole aortic arch, but can also develop during later follow-up.

Transcatheter Stent Therapy in Children: An Update

“…Recoarctation can occur both after surgery [188][189][190] and following balloon angioplasty [74,191,192] Development of post-surgical recoarctation does not depend on the type of surgical repair, but the age at surgery [188,189], hypoplasia of the aortic arch [190] and short body length [190] were shown to be risk factors for recoarctation. Factors predictive of post-balloon angioplasty re-stenosis are young age and severely narrowed isthmus and coarcted segment [74,[191][192][193], very similar to those after surgery.…”

Comparison of different surgical techniques for repair of aortic coarctation in childhood

“…Similarly, recoarctation was shown to be higher in patients who underwent surgical repair during newborn period or early infancy. [13,14] Additionally, there was no significant difference between surgical techniques in terms of recoarctation.…”

Coarctation repair—redo challenges in the adults: what to do?

“…After ligation and division of the ductus arteriosus, the coarctation segment is resected and the aortic arch is opened on its inferior aspect, followed by end-to-end anastomosis of the opened arch and the descending aorta. The procedure can be performed with low peri-operative mortality and reports show relatively low re-coarctation rates of 4% to 13% (19,(35)(36)(37)(38)(39)(40).…”