Risk factors of mortality and recoarctation after coarctation repair in infancy

Abstract

OBJECTIVES The main challenge of aortic coarctation (CoA) repair in infants is to obtain durable results without morbidity. We aimed to describe predictors of aortic arch reintervention after aortic CoA repair. METHODS Between January 2000 and March 2014, we retrospectively included consecutive infants with isolated CoA or CoA with ventricular septal defect (CoA + VSD) who had surgical repair of the aortic arch before 3 months of age. RESULTS Five hundred and thirty patients were included: 308 (58%) patients had isolated CoA and 222 (42%) patients had CoA + VSD. Three hundred and eighty-five patients (72.6%) had CoA repair, 51 patients (9.6%) had CoA repair with closure of VSD and 94 patients (17.8%) had CoA repair with pulmonary artery banding. Mean age at operation was 13 ± 1.6 days, with 294 patients (55.5%) operated on before 2 weeks. Median follow-up was 7.57 years. Sixty-one patients (11.5%) needed reintervention on the aortic arch. Freedom from aortic arch reintervention was 90% at 1 year and 88.5% at 5 years. Proportions 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 recoarctation compared to the extended end-to-side repair (P = 0.033). The risk factors of aortic arch reintervention were age at repair <15 days (P = 0.034) and the need for PGE1 infusion at surgery (P = 0.0043). CONCLUSIONS CoA repair in young infants has an overall good outcome. The use of PGE1 may modify the aortic arch anatomy and mask the boundaries of the resection to be performed. PGE1 treatment should be studied more specifically in another study to improve preoperative management.

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

“…After assessing the full text of the included 67 articles, we excluded 59 of them for not meeting all inclusion criteria. Finally, 18 studies were included in the systematic review for qualitative synthesis [9,[12][13][14][18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

“…The studies characteristics and clinical parameters, along with the main results of the included studies, are summarized in Tables 1, 2, 3, 4. Thirteen [9,[12][13][14][19][20][21][22][24][25][26][27]29] of the included studies were rated as "Good" and five studies [18,23,28,30,31] as "Fair" according to the Quality Assessment Tools (this evaluation is summarized in Online Resource 1). We included 18 studies that recruited a total of 2891 patients from eight different countries.…”

“…The effect of age at time of intervention was examined in six studies [12][13][14]18,19,24]; only two studies found a significant association between younger age at repair and recoarctation: Exp(B)=0.98 (p=0.034) [12] and OR=1.06 (p=0.05) [14], respectively. Also, eight studies [12][13][14]18,19,24,28,29] assessed the effects of weight before surgery on the outcome, with only two studies showing a significant association between low weight at repair and arch restenosis: OR=0.016 (p=0.047) [28] and OR=1.97 (p<0.0001) [18]. In addition, Gorbatykh et al [18] noted that the weight was not a significant risk factor when included on a multivariable model with the different surgical strategies.…”

“…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]. Regardless of the technique used, nowadays, surgery success is defined by the achievement of a durable repair with low morbidity [12].…”

“…There have been several studies evaluating risk factors for adverse outcomes after surgical intervention, including recoarctation, although the literature is often conflicting and inconclusive, especially regarding the influence of child weight and surgical strategy on the rate of reinterventions [7,8,13,14]. Other possible risk factors identified in individual studies include anatomical and morphological characteristics of the aortic arch, preoperative care, and age at time of the intervention [12,14,15]. Nevertheless, a comprehensive analysis of the evidence to determine the risk factors conclusively lacks in the literature.…”