Acquired cardiovascular disease
Contemporary patterns of surgery and outcomes for aortic coarctation: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

Read at the 38th Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 27-30, 2012.
https://doi.org/10.1016/j.jtcvs.2012.09.053Get rights and content
Under an Elsevier user license
open archive

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.

Abbreviations and Acronyms

ASD
atrial septal defect
C/HAA
coarctation or hypoplastic aortic arch
CPB
cardiopulmonary bypass
LHAC
left heart aorta complex
PA
pulmonary artery
PDA
patent ductus arteriosus
PFO
patent foramen ovale
STS
Society of Thoracic Surgeons
STS-CHSD
Society of Thoracic Surgeons Congenital Heart Surgery Database
VSD
ventricular septal defect

CTSNet classification

20
26

Cited by (0)

Disclosures: Dr Pasquali has received grant support from the National Heart, Lung, and Blood Institute (1K08HL103631-01). Dr Jacobs is Chair, Society of Thoracic Surgeons Congenital Heart Surgery Database Task Force. All other authors have nothing to disclose with regard to commercial support.