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Coarctation Repair in Neonates and Young Infants - Is small size still a risk factor?
P. T. Burch, C. Cowley, D. Null, L. Lambert, P. C. Kouretas*, J. A. Hawkins*. The University of Utah, Salt Lake City, UT,
BACKGROUND:
Previous reports of neonatal coarctation repair demonstrate a high rate of recurrent arch obstruction particularly in small neonates. This study was designed to assess the impact of low weight on recurrent obstruction and survival in neonates and infants undergoing repair of simple aortic coarctation.
METHODS:
From 1996 to 2006, 177 neonates and infants <90 days of age with simple coarctation (isolated coarctation or coarctation with hemodynamically insignificant VSD) underwent repair. Median patient age was 16 days (range 1-87 days) with 128 <30 days, 25 age 31-60 days, and 23 age 61-90 days. Median patient weight was 3.4 kg (range 0.8 to 6.0 kg) with 33 patients <2.5 kg and 144 patients >2.5 kg. Repair consisted of resection and extended end-to-end anastomosis in all patients. 174 patients underwent repair via left thoracotomy while 3 required median sternotomy and cardiopulmonary bypass. Outcomes were analyzed for survival and recurrent arch obstruction.
RESULTS:
There were no early deaths. Median follow-up of 5.8 years (range 1.0-11.0 yrs) demonstrated 1 late death unrelated to recurrent coarctation in an infant weighing <2.5 kg at the time of initial repair. Seventeen patients required intervention for recurrent arch obstruction at a median of 0.4 yrs postoperatively (range 0.1-1.5 yrs). All patients were treated successfully with balloon angioplasty and required no additional intervention. Actuarial freedom from reintervention was 92% at 1 year and 91% at 10 years for infants >2.5 kg and for infants <2.5 kg was 91% at 1 year and 88% at 10 years (p=N.S.). Also, there was no difference between survival or need for reintervention for neonates <30 days compared to infants 31-90 days of age. CONCLUSIONS:
Low weight does not negatively affect survival or recurrent arch obstruction after aortic coarctation repair in neonates and infants less than 3 months of age. Balloon angioplasty is an effective treatment for recurrent arch obstruction in infants. These results indicate that delayed surgical intervention to achieve somatic growth is not indicated in the current era.
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