Surgical repair of coarctation of aorta in neonates and infants: a 10 years experience

Background: This study reviews the experience of a single center with surgery for coarctation of aorta (CoA) in neonates and infants over 10 years. Methods: Thirty five neonates and 56 infants, a total of 91 patients (mean age 3 months, min. 8 days - max. 11 months) who were operated for CoA in our clinic between June 1996 and June 2006, were retrospectively included in the study. The present cohort is similar to recent series in the literature, where neonates and infants predominate and severe cardiovascular morbidity is frequent. End-to-end anastomosis was the most used technique (74.7%) in both neonates and infants. Results: Postoperative systemic hypertension was seen with a higher incidence in infants. None of the patients, except the ones with significant gradient at the repaired segment and who had reintervention, required antihypertensive medication six months after surgery. During a mean follow-up period of 44 months (range, 23 to 118 months). 13 patients (12.1%) demonstrated recoarctation. 3.3% of the patients were treated for recoarctation by surgery and 7.7% of the patients had endovascular intervention. Mortality in both the early and late postoperative periods was 2.2%. Overall mortality over the whole duration of follow-up was 4.4%. The probability of avoiding death, reintervention for CoA, and cardiovascular complications in the entire study population was 93.4%, 90.1% and 83.5% 1, 5 and 10 years after surgery, respectively. During follow-up complications occurred almost equally in both groups. Conclusion: Although surgical repair for CoA seems to be the gold standard, it is still associated with mortality and morbidity and there is still a need for reintervention. These patients therefore need careful and close follow-up which is as important as timing and technique of surgery.