title: Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.
abstract: OBJECTIVE
  The objective of this study was to describe characteristics and early outcomes across a large multicenter cohort undergoing coarctation or hypoplastic aortic arch repair.
  
  
  METHODS
  Patients undergoing coarctation or hypoplastic aortic arch repair (2006-2010) as their first cardiovascular operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database were included. Group 1 patients consisted of those with coarctation or hypoplastic aortic arch without ventricular septal defect (coarctation or hypoplastic aortic arch, isolated); group 2, coarctation or hypoplastic aortic arch with ventricular septal defect (coarctation or hypoplastic aortic arch, ventricular septal defect); and group 3, coarctation or hypoplastic aortic arch with other major cardiac diagnoses (coarctation or hypoplastic aortic arch, other).
  
  
  RESULTS
  The cohort included 5025 patients (95 centers): group 1, 2705 (54%); group 2, 840 (17%); and group 3, 1480 (29%). Group 1 underwent coarctation or hypoplastic aortic arch repair at an older age than groups 2 and 3 (groups 1, 2, and 3, 75%, 99%, and 88% <1 year old, respectively; P < .0001). The most common operative techniques for coarctation or hypoplastic aortic arch repair (group 1) were end-to-end (33%) or extended end-to-end (56%) anastomosis. Overall mortality was 2.4%, and was 1%, 2.5%, and 4.8% for groups 1, 2, and 3 respectively (P < .0001). Ventricular septal defect management strategies for group 2 patients included ventricular septal defect closure (n = 211, 25%), pulmonary artery band (n = 89, 11%), or no intervention (n = 540, 64%) without significant difference in mortality (4%, 1%, 2%; P = .15). Postoperative complications occurred in 36% of patients overall and were more common in groups 2 and 3. There were no occurrences of spinal cord injury (0/973).
  
  
  CONCLUSIONS
  In the current era, primary coarctation or hypoplastic aortic arch repair is performed predominantly in neonates and infants. Overall mortality is low, although those with concomitant defects are at risk for higher morbidity and mortality. The risk of spinal cord injury is lower than previously reported.
authors.affiliation: Department of Cardiothoracic Surgery, Brenner Children's Hospital, Wake Forest Baptist Health, Winston Salem, NC, USA. rungerle@wakehealth.edu
authors.forename: Ross M
authors.initials: RM
authors.lastname: Ungerleider
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.forename: Amelia S
authors.initials: AS
authors.lastname: Wallace
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ootaki
authors.forename: Michael D
authors.initials: MD
authors.lastname: Quartermain
authors.forename: Derek A
authors.initials: DA
authors.lastname: Williams
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
mesh_terms: D000015:Abnormalities, Multiple; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000601:surgery*; D001017:Aortic Coarctation / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009656:North America; D011183:Postoperative Complications / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D013997:Time Factors; D016896:Treatment Outcome