Repair of coarctation of the aorta in infants weighing less than 2 kilograms.
BACKGROUND
We retrospectively reviewed our experience in aortic coarctation repair on infants weighing less than 2 kg to evaluate the results and assess the rate of recoarctation in this group of patients.


METHODS
Twenty-four consecutive babies weighing 2 kg or less were operated on over a period of 15 years. Median gestational age was 33 weeks (range, 30 to 36), and median weight was 1.6 kg (range, 1.0 to 2.0). Seventeen of them had associated cardiac anomalies. The methods of repair undertaken were resection with extended end-to-end anastomosis (n = 13), subclavian flap angioplasty (n = 9), carotid flap angioplasty (n = 1), and patch repair using pulmonary homograft tissue (n = 1).


RESULTS
Mean follow-up was 52.5 months (range, 0.5 to 151). There were 3 in-hospital deaths and 2 late deaths. Recoarctation developed in 7 babies. Four underwent balloon dilatation; 1 of them required further surgery; 3 others have mild recoarctation, but have not required further intervention. Risk factor analyses revealed that the presence of preoperative congestive cardiac failure, and coexisting noncardiac lesions as well as the duration of descending aortic cross-clamp and postoperative ventilation had a significant influence on mortality after repair.


CONCLUSIONS
Coarctation repair in infants less than 2 kg can be performed safely. The incidence of recoarctation is acceptable and comparable with that of other pediatric cohorts that have been reported. Preoperative cardiac function and associated noncardiac lesions may influence the incidence of mortality after repair. Delaying the timing of surgical repair to achieve growth is not necessary.
Sudarshan
Catherine D
CD
Cardiac Surgery Unit, Royal Children's Hospital, Parkville, Victoria, Australia.
Cochrane
Andrew D
AD
Jun
Zhang H
ZH
Soto
Rodrigo
R
Brizard
Christian P
CP
D000015:Abnormalities, Multiple / Q000601:surgery; D000714:Anastomosis, Surgical; D001017:Aortic Coarctation / Q000601:surgery*; D001705:Bioprosthesis; D001724:Birth Weight; D001835:Body Weight; D002404:Catheterization; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D006819:Hyaline Membrane Disease / Q000150:complications; D007021:Hypospadias / Q000150:complications / Q000601:surgery; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D013524:Surgical Flaps; D016019:Survival Analysis; D016896:Treatment Outcome