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J Thorac Cardiovasc Surg 2008;136:1229-1236
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Perioperative course in 118 infants and children undergoing coarctation repair via a thoracotomy: A prospective, multicenter experience

^a Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^b Los Angeles Children's Hospital, Los Angeles, California
^c Children's Memorial Hospital, Chicago, Illinois
^d Children's Hospital of Wisconsin, Milwaukee, Wisconsin
^e Cleveland Clinic Foundation, Cleveland, Ohio

Received for publication November 27, 2007; revisions received May 7, 2008; accepted for publication June 15, 2008.

^_* Address for reprints: Sarah Tabbutt, MD, PhD, Medical Director, Cardiac Intensive Care Unit, The Cardiac Center, The Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104. (Email: tabbutt{at}email.chop.edu).

Objective: The hospital course for pediatric coarctation repair has not been described. We had 4 aims: (1) to determine the influence of age, anatomy, and type of repair on aortic crossclamp time, (2) to determine the impact of age or aortic crossclamp time on postoperative morbidity, (3) to describe current antihypertensive strategies, and (4) to describe antihypertensive medications at hospital discharge.

Methods: Data were obtained from a prospective randomized multicenter esmolol safety and efficacy trial. The study included patients who were scheduled for a coarctation repair receiving esmolol as their first-line antihypertensive medication in the operating room (n = 118; weight 2.5 kg and age < 6 years).

Results: (1) Patient age and type of coarctation did not affect the aortic crossclamp time. (2) Younger age, but not aortic crossclamp time, was associated with a significantly longer time to extubation and longer hospital length of stay. (3) A combination of esmolol and sodium nitroprusside (Nipride, Roche, Basel, Switzerland) provided excellent early blood pressure control. (4) At discharge, 64% of patients were receiving antihypertensive medications. Older patients were more likely to be discharged with antihypertensive medication (91% of patients aged 2–6 years, P < .0002).

Conclusion: The study describes a multi-institutional approach to the repair of isolated coarctation in infants and children. Patients repaired by end-to-end anastomosis had shorter aortic crossclamp time, younger patients had longer hospital length of stay, a majority of patients had sodium nitroprusside (Nipride) added to esmolol for early blood pressure control, and older patients were more likely to be discharged with antihypertensive medication.