Aortic Coarctation Repair Outcomes Based on Surgical Approach and Age

Background: Coarctation of the aorta, or narrowing of the aorta, accounts for 6-8% of all congenital heart defects. The two most common surgical techniques for repair of coarctation are coarctectomy with end-to-end anastomosis, performed via a lateral thoracotomy approach, and patch aortoplasty, performed via median sternotomy. The purpose of this study is to identify surgical variables that affect long-term outcomes of repair. Methods: This is a retrospective cohort study of patients under one year of age who underwent coarctation repair at Cook Children's Medical Center between January 1, 2014 and March 1, 2018. Exclusion criteria included patients who had complex coexisting cardiac malformations other than atrial septal defect (ASD) or ventricular septal defect (VSD). Using Fisher's Exact test, relationships were examined between type of surgery (lateral thoracotomy vs. medial sternotomy), age at surgery (0-30 vs. 31-365 days), and transverse aortic arch measurement (?-3 vs. >-3 z-score) with elevated blood pressure and incidence of recurrent coarctation. Results: There were 64 patients that met study criteria. We found that type of surgery, age at surgery, and transverse aortic arch measurement had no significant association (p > 0.05) with either blood pressure or recurrence of coarctation. Conclusion: The current data does not support an association between the studied variables and either systemic hypertension and recurrent coarctation. However, the sample size is limited which limits the statistical power of our current study. Increasing the length of time reviewed may identify clinically important relationships.