Original article: cardiovascular
Surgery for coarctation of the aorta in infants weighing less than 2 kg

https://doi.org/10.1016/S0003-4975(00)02664-3Get rights and content

Abstract

Background. Low- and very low-birth weight infants are now candidates for reparative cardiac surgery. Outcomes after coarctation repair have not been characterized in this patient population.

Methods. We performed a retrospective review of 18 consecutive neonates less than 2 kg who underwent repair of aortic coarctation between August 1990 and December 1999.

Results. Median weight was 1,330 g, and median gestational age was 31 weeks. A ventricular septal defect was present in 5 patients, and Shone’s complex in 4. Sixteen patients had resection and end-to-end anastomosis, and 2 had resection and subclavian flap. Median clamp time was 15.5 minutes. One patient died during hospitalization. Two patients died late postoperatively (5-year estimated survival 80%). Mean follow-up was 28.5 months. Eight patients (44%) had a residual or recurrent coarctation, 5 underwent balloon dilation, and 3 underwent reoperation. Freedom from reintervention for recoarctation was 60% at 5 years. Shone’s complex or a hypoplastic arch was an independent risk factor for decreased survival (p < 0.001). Very low birth weight was a multivariate predictor for increased risk of recoarctation (p = 0.01).

Conclusions. Coarctation repair in less than 2-kg premature non-Shone’s infants can be performed with a low mortality. The rate of recoarctation is higher in the very low-birth weight infants, but can be managed with low risk.

Section snippets

Patient characteristics

Between August 1990 and December 1999, 18 consecutive neonates with a birth weight of less than 2 kg (median weight at surgery 1,330 g, range 800 to 1,950 g) underwent surgery for critical aortic coarctation at The Children’s Hospital (Boston, MA). This study was begun in 1990 because a previous study on low-birth weight neonates from our institution [2] spanned up to that date. All charts were retrospectively reviewed, including follow-up clinic notes and latest echocardiograms. All data

Operative results

All patients were operated on via a left posterolateral thoracotomy. The coarctation was resected and a primary end-to-end anastomosis was performed in 16 (89%) patients (with extension into the arch in 9), and 2 patients underwent resection of the coarctation and reverse subclavian flap augmentation of the distal arch with end-to-end anastomosis. In all cases, a running suture of 6-0 or 7-0 polypropylene was used. The median clamp time was 15.5 minutes (12 to 41 minutes). Arm-leg gradients

Comment

Repair of cardiac defects in low-birth and very low-birth weight neonates is increasingly performed in a reparative rather than palliative manner [1]. This study shows that this concept is also valid in this high-risk population. Small or obstructive left-sided structures and a hypoplastic aortic arch were risk factors for death, whereas very low-birth weight was associated with increased recoarctation rates.

Reported mortality rates for coarctation repair in low-birth infants vary from 12.5% to

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