Predictors for Reintervention after Surgical Coarctation Repair through Left Thoracotomy

Abstract

Background: Recoarctation of the aorta may occur in infants after the primary surgical repair. Several risk factors were suggested in the literature, with controversial results among the studies. Objective: This study was conducted to evaluate the predictors for reintervention after surgical coarctation repair by different techniques through left thoracotomy. Patients and Methods: A retrospective analysis was performed for patients who underwent isolated surgical coarctation repair or with pulmonary artery band between Sep 2014 and December 2018. All primary intervention was through thoracotomy. Reintervention was defined as the need for balloon angioplasty or reoperation. Results: A total of 47 patients with median age at repair of 7 days. The median duration of follow-up was 18 months (95% CI=14 to 22 months). Only 7 (14.9%) patients required reintervention. No mortality was recorded during the follow-up period. Cox proportional hazard analysis showed that only postoperative pressure gradient was an independent risk factor for reintervention. Receiver operating characteristic curve showed that postoperative pressure gradient was an excellent indicator (AUC = 0.948, 95% CI: 0.841 to 0.992, p<0.001), with the optimal cut-off value >25, sensitivity of 100% and specificity of 80%. Conclusions: Repair of aortic coarctation through thoracotomy has an overall good outcome. However, reintervention is required in some patients and elevated pressure gradient on echocardiographic assessment <25 can exclude recoarctation.