Surgery for coarctation of the aorta in infants weighing less than 2 kg.
BACKGROUND
Low- and very low-birth weight infants are now candidates for reparative cardiac surgery. Outcomes after coarctation repair have not been characterized in this patient population.


METHODS
We performed a retrospective review of 18 consecutive neonates less than 2 kg who underwent repair of aortic coarctation between August 1990 and December 1999.


RESULTS
Median weight was 1,330 g, and median gestational age was 31 weeks. A ventricular septal defect was present in 5 patients, and Shone's complex in 4. Sixteen patients had resection and end-to-end anastomosis, and 2 had resection and subclavian flap. Median clamp time was 15.5 minutes. One patient died during hospitalization. Two patients died late postoperatively (5-year estimated survival 80%). Mean follow-up was 28.5 months. Eight patients (44%) had a residual or recurrent coarctation, 5 underwent balloon dilation, and 3 underwent reoperation. Freedom from reintervention for recoarctation was 60% at 5 years. Shone's complex or a hypoplastic arch was an independent risk factor for decreased survival (p < 0.001). Very low birth weight was a multivariate predictor for increased risk of recoarctation (p = 0.01).


CONCLUSIONS
Coarctation repair in less than 2-kg premature non-Shone's infants can be performed with a low mortality. The rate of recoarctation is higher in the very low-birth weight infants, but can be managed with low risk.
Bacha
E A
EA
Department of Cardiac Surgery, The Children's Hospital, Boston, Massachusetts, USA. ebacha@surgery.bsd.uchicago.edu
Almodovar
M
M
Wessel
D L
DL
Zurakowski
D
D
Mayer
J E
JE
Jonas
R A
RA
del Nido
P J
PJ
D000704:Analysis of Variance; D001017:Aortic Coarctation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000401:mortality*