Background: Advances in aortic coarctation (CoA) repairs now focus on reducing restenosis and hypertension. There is debate overusing median sternotomy, which may reduce re-coarctation, versus lateral thoracotomy, which avoids bypass; anatomical factors influence the method chosen. Re-coarctation rates vary (5–30%), impacted by arch size, low weight, and age. While balloon angioplasty is less invasive, it has high restenosis risk in neonates; high-pressure balloons may help. Evidence from prior studies is limited due to short follow-up, small cohorts, and retrospective design.
Aim: To identify risk factors contributing to recoarctation following surgical repair in a cohort of one hundred patients with coarctation, and to examine the role of catheter-based interventions in the management of restenosis.
Methods: This single center experience retrospective cross-sectional study was conducted from January 2017 to December 2023 and involved 100 patients with congenital heart disease (CHD) and CoA who underwent surgical treatment. The study included patients aged from 1 to 30 days at the time of surgery who exhibited significant post-surgical stenosis, as confirmed by dynamic or echocardiographic findings. However, patients with hypoplastic left heart syndrome who had undergone Norwood surgery were excluded from the analysis.
Results: Postoperative assessments demonstrated a substantial improvement in left ventricular function, with 84% of patients exhibiting good outcomes. The incidence of postoperative complications (with or without recoarctation) was elevated at 64%, predominantly due to cardiac-related issues. Notably, lower operative weight was identified as a significant predictor of surgical failure with recoarctation (gradient more than 20 mmHg with or without impaired LV function) (p = 0.002). During the follow-up period ranging from three months to 1.5 years, 16 patients (16%) underwent catheter intervention for management of recoarctation, there were no reported mortalities, although one patient required surgical reintervention.
Conclusion: This study endorsed the significance of patient weight at the time of operation as a robust predictor of surgical failure and the need for postoperative catheterization in infants with recoarctation of the aorta. While cardiac and noncardiac anomalies also contribute to the likelihood of requiring reintervention, weight remains the most consistent and statistically significant factor. The role of refined endovascular modalities, such as balloon angioplasty, continues to be vital in managing recoarctation, particularly in low-weight infants. Overall, these insights contribute to a deeper understanding of the risk factors and management approaches for Recoarctation in infants, aiming to improve long-term outcomes in this vulnerable population.
Keywords: Catheter intervention; Coarctation of the aorta; Post-surgical re-coarctation; Stenosis.