title: Contemporary Results of Aortic Coarctation Repair Through Left Thoracotomy.
abstract: BACKGROUND
  Although surgical results for repair of coarctation of the aorta (CoA) have steadily improved, management of this condition remains controversial. The purposes of this study were to analyze the long-term outcomes of patients undergoing CoA repair through left thoracotomy and to define risk factors for reintervention.
  
  
  METHODS
  All patients who were less than 18 years old and who underwent initial repair of CoA through left thoracotomy from 1995 to 2013 at Texas Children's Hospital (Houston, TX) were included. Patients were classified into 3 groups: 143 (42%) neonates (0 to 30 days old), 122 (36%) infants (31 days to 1 year old), and 78 (23%) older children (1 to 18 years old). Univariate and multivariate analyses were performed.
  
  
  RESULTS
  A total of 343 patients (129 [38%] girls) with median age of 53 days (interquartile range [IQR],12 days to 9 months) and weight of 4.1 kg (IQR, 3.1 to 8.0) underwent repair with extended end-to-end anastomosis (291 patients [85%]), end-to-end anastomosis (44 patients [13%]), interposition graft (2 patients [0.6%]), or subclavian flap (6 patients [2%]). Concomitant diagnoses included genetic abnormalities (48 patients [14%]), isolated ventricular septal defects (58 patients [17%]), small left-sided structures (53 patients,16%), or other complex congenital heart disease (18 patients [5%]). Perioperative mortality was 1% (n = 4, all neonates). At a median follow-up of 6 years (7 days to 19 years), only 14 (4%) patients required reintervention (10 catheter-based procedures, 6 surgical repairs). A postoperative peak velocity of 2.5 m/s or greater was an independent risk factor for reintervention (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.4 to 11.6). Within the cohort, 95 (33%) patients were hypertensive or remained on cardiac medications a median of 12 years (6 months to 19 years) after the surgical procedure. Development of perioperative hypertension was associated with higher risk of chronic hypertension or cardiac medication dependency (OR, 1.9; 95% CI, 1.1 to 3.3).
  
  
  CONCLUSIONS
  CoA repair through left thoracotomy is associated with low rates of morbidity, mortality, and reintervention. Aortic arch obstruction should be completely relieved at the time of surgical intervention to minimize the risk of long-term recoarctation.
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas. Electronic address: cmmery@texaschildrens.org.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Mery
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Guzmán-Pruneda
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Trost
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas.
authors.forename: Ericka
authors.initials: E
authors.lastname: McLaughlin
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Smith
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas.
authors.forename: Dhaval R
authors.initials: DR
authors.lastname: Parekh
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Iki
authors.initials: I
authors.lastname: Adachi
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Heinle
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: E Dean
authors.initials: ED
authors.lastname: McKenzie
authors.affiliation: Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
mesh_terms: D000293:Adolescent; D001017:Aortic Coarctation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods