Factors associated with arch reintervention and growth of the aortic arch after coarctation repair in neonates weighing less than 2.5 kg.
OBJECTIVE
Neonates weighing less than 2.5 kg with aortic coarctation are challenging. We sought to find the prevalence of death or aortic arch reintervention and their determinants after coarctation repair. We also sought to define growth trajectories for postrepair aortic arch dimensions and identify factors associated with accelerated longitudinal growth.


METHODS
We reviewed neonates weighing less than 2.5 kg undergoing coarctation repair between 1993 and 2004. Competing-risks methods determined time-related prevalences of death, arch reintervention, and survival without subsequent reintervention. Mixed regression analysis modeled longitudinal growth trajectories of echocardiographically derived aortic arch dimensions.


RESULTS
Thirty-six neonates underwent coarctation repair. Initial repair type was simple end to end (n = 3), extended end to end (n = 16), subclavian flap aortoplasty (n = 15), and patch aortoplasty (n = 2). Median initial repair age was 11 days (range 2-69 days) and mean weight was 2.01 +/- 0.33 kg. Overall 1-year survival was 76%. After 1 year from initial repair, 19% had died without subsequent reintervention, 14% underwent arch reintervention, and 67% remained alive without arch reintervention. Neonates with extended end-to-end repairs had increased transverse aortic arch Z-scores (P = .004). Although patients with larger initial transverse aortic arch Z-scores had higher scores across all time points (P < .001), neonates with the smallest transverse aortic arch Z-scores had accelerated growth trajectories (P < .001). Aortic isthmus growth was likewise accelerated in neonates with the smallest initial aortic isthmus Z-score (P < .001).


CONCLUSIONS
Mortality and arch reintervention are common after initial repair of coarctation of the aorta in neonates weighing less than 2.5 kg. Catch-up growth of both the transverse arch and isthmus occurs after coarctation repair, especially in those with the smallest arch parameters, and may be increased by using an extended end-to-end technique.
Karamlou
Tara
T
Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
Bernasconi
Alessandra
A
Jaeggi
Edgar
E
Alhabshan
Fahad
F
Williams
William G
WG
Van Arsdell
Glen S
GS
Coles
John G
JG
Caldarone
Christopher A
CA
D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001013:Aorta, Thoracic / Q000254:growth & development* / Q000601:surgery; D001017:Aortic Coarctation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D001724:Birth Weight; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome