Predictive factors of surgical repair technique in infants with coarctation of the aorta

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AIMS: Coarctation of the aorta (CoA) is the most common undiagnosed congenital heart disease (CHD) during pre-natal screening and its overall prognosis relies on the quality of the surgical repair. This study aimed to identify the pre-natal and post-natal factors associated with the type of surgical technique repair in infant CoA. METHODS AND RESULTS: Multicentre, retrospective, observational study in 680 infants (68% males) aged <1 year who underwent CoA surgical repair in 4 CHD surgical centres in France over 11 years. The primary outcome was the surgical repair technique (simple end-to-end repair, extended end-to-end repair, or aortic arch repair). The aortic arch raw diameter, measured by echocardiography just beyond the brachiocephalic arterial trunk, was the most discriminating parameter for the type of surgical repair technique, outperforming the existing Z-score models. Cut-off value of aortic arch diameter ≤3.6 mm in children <1-year old was predictive of an aortic arch repair [area under the curve (95% CI) = 0.76 (0.67;0.86)]. In multivariable analysis, a pre-natal associated cardiac malformation [odd ratio (OR) (95% CI) = 4.39 (1.99; 9.69)] and aortic arch diameter ≤3.6 mm [OR (95% CI) = 3.78 [1.61; 8.62)] were predictive of an aortic arch repair. CONCLUSION: The aortic arch diameter is the most discriminating parameter for the type of surgical repair technique in infant CoA. An aortic arch threshold value of 3.6 mm in infant population is predictive of aortic arch repair and should be considered a practical indicator of the hypoplastic nature of the aortic arch.

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