Long-term Outcomes of Coarctation Repair via Left Thoracotomy.

BACKGROUND: Optimal surgical approach for repair of coarctation of the aorta (CoA) remains controversial. This study aims to evaluate reintervention rates and its predictors using a strategy of resection with extended end-to-end anastomosis (REEEA) via left thoracotomy.

METHODS: A retrospective analysis was performed for all patients who underwent isolated CoA repair or CoA and simultaneous VSD repair via REEEA between Jan 2000-Dec 2015. Patients with complex congenital heart disease were excluded. Transverse arch hypoplasia was defined as echocardiographic z-score < -2 or by documentation in medical/operative reports. Reintervention was defined as need for balloon angioplasty or reoperation. Hypertension was defined as antihypertensive medication use or blood pressure ≥ 95th percentile.

RESULTS: A total of 251 patients with median age at repair of 14.6 days met inclusion criteria. Repair was by left thoracotomy in 226 (90%). Follow-up data were available for 186/251 patients with median follow-up time of 5.4 years (range, 0.2-15.3), of which 169 (91%) underwent thoracotomy. There were no early deaths or early reoperations. A proximal transverse arch z-score < -4.1 or distal transverse arch z-score of < -2.8 was predictive of repair via sternotomy. Only 4 (2%) patients required reintervention (2 balloon angioplasties, 2 reoperations). Transverse arch hypoplasia was a risk factor for reintervention (p=0.048), but surgical approach was not (p=0.35). Late hypertension was identified in only 33/186 (18%) patients.

CONCLUSIONS: Repair of CoA even with associated transverse arch hypoplasia via REEEA through left thoracotomy has a low mortality, low reintervention rate, and low incidence of late hypertension.