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J Thorac Cardiovasc Surg 2009;137:1163-1167
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Factors associated with arch reintervention and growth of the aortic arch after coarctation repair in neonates weighing less than 2.5 kg

^a Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
^b Division of Cardiology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada

Received for publication February 7, 2008; revisions received June 21, 2008; accepted for publication July 26, 2008.

^_* Address for reprints: Christopher A. Caldarone, MD, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. (Email: christopher.caldarone{at}sickkids.ca).

Objectives: Neonates weighing less than 2.5 kg with aortic coarctation are challenging. We sought to find the prevalence of death or aortic arch reintervention and their determinants after coarctation repair. We also sought to define growth trajectories for postrepair aortic arch dimensions and identify factors associated with accelerated longitudinal growth.

Methods: We reviewed neonates weighing less than 2.5 kg undergoing coarctation repair between 1993 and 2004. Competing-risks methods determined time-related prevalences of death, arch reintervention, and survival without subsequent reintervention. Mixed regression analysis modeled longitudinal growth trajectories of echocardiographically derived aortic arch dimensions.

Results: Thirty-six neonates underwent coarctation repair. Initial repair type was simple end to end (n = 3), extended end to end (n = 16), subclavian flap aortoplasty (n = 15), and patch aortoplasty (n = 2). Median initial repair age was 11 days (range 2–69 days) and mean weight was 2.01 ± 0.33 kg. Overall 1-year survival was 76%. After 1 year from initial repair, 19% had died without subsequent reintervention, 14% underwent arch reintervention, and 67% remained alive without arch reintervention. Neonates with extended end-to-end repairs had increased transverse aortic arch Z-scores (P = .004). Although patients with larger initial transverse aortic arch Z-scores had higher scores across all time points (P < .001), neonates with the smallest transverse aortic arch Z-scores had accelerated growth trajectories (P < .001). Aortic isthmus growth was likewise accelerated in neonates with the smallest initial aortic isthmus Z-score (P < .001).

Conclusions: Mortality and arch reintervention are common after initial repair of coarctation of the aorta in neonates weighing less than 2.5 kg. Catch-up growth of both the transverse arch and isthmus occurs after coarctation repair, especially in those with the smallest arch parameters, and may be increased by using an extended end-to-end technique.