Long-Term Surgical Outcomes for Coarctation of the Aorta: A 15-Year Single-Center Experience

Abstract

Objective: To evaluate long-term outcomes following surgical repair of coarctation of the aorta (CoA) in neonates and infants. Materials and Methods: We assessed the operative results in 308 infants with CoA who underwent primary repair at our institute between 2008 and 2023. All of the patients were <12 months of age when they had their operation. Results: The overall mortality rate was 3.9% (12/308), with critical CoA identified as the only independent predictor of death. Recoarctation occurred in 8.1% (25/308) of patients, and the significant predictors of recoarctation included low body weight at the time of surgery, use of the lateral thoracotomy approach, aortic arch remodeling, and the use of absorbable sutures. Postoperative arterial hypertension was observed in 20.4% (63/308) of cases. Independent predictors of hypertension included gothic arch morphology and a left ventricular mass index (LVMI) greater than 59 g/m². Conclusions: The choice of surgical strategy significantly affects the risk for development of recoarctation. Median sternotomy with the use of native tissue for anastomosis reduces the risk of recoarctation. The shape of the aortic arch is a predictor of long-term complications. Lowering the risk of recoarctation is the Romanesque-type aortic arch and increasing the risk of arterial hypertension is the Gothic-type arch. The strongest predictor for arterial hypertension was a LVMI greater than 59 g/m².