OPERATIVE RISK-FACTORS AND DURABILITY OF REPAIR OF COARCTATION OF THEAORTA IN THE NEONATE

The risk factors for the operative mortality and long-term durability of repair after surgical correction of coarctation of the aorta in neo nates remain controversial. Between January 1970 and January 1993, 139 patients under 1 month of age underwent repair of coarctation of the aorta. Complex intracardiac defects were present in 59 patients. Anoth er 44 patients had an associated ventricular septal defect. Subclavian artery nap repair was performed in 92 patients; end-to-end anastomosi s (38 patients) and patch angioplasty (9 patients) were performed less commonly. The hospital mortality was significantly higher in patients with complex intracardiac defects (9 of 59 patients; 15.2%) than in t hose with a ventricular septal defect (1 of 44 patients; 2.3%) or with isolated coarctation (none of 36 patients; p = 0.007). Elevated pulmo nary artery diastolic pressure (p = 0.041) and complex intracardiac an omalies (p = 0.048) were found to be independent predictors of hospita l mortality. The presence of a complex cardiac defect (p < 0.001) was an independent predictor of poor long-term survival. Recurrent stenosi s requiring reoperation had occurred or balloon dilation had been nece ssary in 27.9% of the children at 5 years postoperatively. In patients followed up for at least 5 years, the recurrence-free survival was be tter in those who had undergone subclavian artery nap repair than in t hose who had undergone end-to-end repair (p = 0.017). When coarctation of the aorta must be repaired in the neonate, operative mortality and long-term survival are affected by the complexity of associated intra cardiac anomalies. The subclavian artery nap repair of aortic coarctat ion in neonates was found to result in a lower rate of recurrent steno sis in patients followed up for at least 5 years postoperatively.