OUTCOMES IN SERIOUSLY ILL NEONATES WITH COARCTATION OF THE AORTA - A MULTIINSTITUTIONAL STUDY

Among 326 severely symptomatic neonates with coarctation with or witho ut ventricular septal defect, four died before an initial procedure wa s performed. Among the 322 undergoing an initial procedure, survival f or at least 24 months was 84%; the hazard function for death was lower initially but more prolonged in patients without than in those with v entricular septal defect. Important mitral valve anomalies coexisted i n 5% of patients, left ventricular hypoplasia in 5% (more commonly in patients without ventricular septal defect), narrowing of the left ven tricular outflow tract in 9% (more common in patients without ventricu lar septal defect), and narrowing of the proximal arch in 1%; one or m ore of these anomalies was present in most patients without ventricula r septal defect who died, Five percent of the 322 patients had more th an one of these coexisting anomalies, and 8% had just one. The most co mmonly used technique of repair of the coarctation was resection and e nd-to-end anastomosis, but no technique was a risk factor for death by multivariable analysis. Extension of the area of resection so that th e end-to-end anastomosis was proximal to the left subclavian artery bu t distal to the left common carotid artery did not increase risk; exte nsions beyond this, and in the case of patch graft repair, extensions proximal to the left subclavian artery, did increase risk. Patch graft repair was associated with the highest prevalence (21%) of reinterven tion to the coarctation repair. Among patients with coexisting moderat e-sized or large ventricular septal defects, repair of the coarctation , pulmonary trunk banding, and subsequent repair of the defect were as sociated with the highest 2-year survival, 97% in those with single ve ntricular septal defect. The risk-adjusted outcomes in two institution s were less good than in all others.