Comparing acute and long-term outcome of critical neonatal native aortic coarctation treated by combined stent-surgery approach or by primary surgery

Abstract

Background: In neonates with critical aortic coarctation (CoA) primary stenting of CoA may serve as therapeutic bridging until definitive surgical repair. Methods: Comparative study of acute and long-term outcome of neonates with critical CoA treated by combined stent-surgery approach, or by primary surgery. Complications, re-intervention rate, clinical and echocardiographic findings of left ventricular (LV) function were compared. Results: Between 2012 and 2014, we treated 20 neonates at a median age of 9 (7–51) days and a body weight of 3.6 (3–4.1) kg. We compared 10 neonates treated by primary CoA stenting and secondary surgery with stent removal and CoA repair with 10 age-matched infants with primary surgical CoA repair. There was no early or late mortality. Perioperative complications and rate of re-intervention were comparable in both groups. LV function was reduced before first intervention ejection fraction (EF) 39% (30–42), shortening fraction 27% (20–32), more affected in the stent group, but recovered after stenting until secondary surgery (EF 30% vs. EF 40%, p = 0.01) and normalized until last follow-up (EF 62%, p < 0.01) resp. after primary repair until discharge (EF 60%, p < 0.01). At last follow-up, at an age of 5.2 (4.8–5.9) years, all children were asymptomatic (NYHA 1), without arterial hypertension, or cardiac medication, and with normal LV function and LV mass. Conclusions: The combined stent-surgery approach for critical CoA is an alternative treatment leading to comparable acute and long-term results. It allows LV remodelling before secondary corrective surgery with stent removal via a regular left lateral approach under cross-clamping the aortic arch.

Keywords

• Coarctation of the aortic arch
• Stent
• Neonate
• Outcome