Surgery for coarctation of the aorta in infants weighing less than 2 kg

Background. Low- and very low-birth weight infants are now candidates for r eparative cardiac surgery. Outcomes after coarctation repair have not been characterized in this patient population. Methods. We performed a retrospective review of 18 consecutive neonates les s 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 comple x in 4. Sixteen patients had resection and end-to-end anastomosis, and 2 ha d resection and subclavian flap. Median clamp time was 15.5 minutes. One pa tient died during hospitalization. Two patients died late postoperatively ( 5-year estimated survival 80%). Mean follow-up was 28.5 months. Eight patie nts (44%) had a residual or recurrent coarctation, 5 underwent balloon dila tion, and 3 underwent reoperation. Freedom from reintervention for recoarct ation was 60% at 5 years. Shone's complex or a hypoplastic arch was an inde pendent risk factor for decreased survival (p < 0.001). Very low birth weig ht was a multivariate predictor for increased risk of recoarctation (p = 0. 01). Conclusions. Coarctation repair in less than 2-kg premature non-Shone's inf ants can be performed with a low mortality. The rate of recoarctation is hi gher in the very low-birth weight infants, but can be managed with low risk . (C) 2001 by The Society of Thoracic Surgeons.