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Ann Thorac Surg 2001;71:1260-1264
© 2001 The Society of Thoracic Surgeons
a Department of Cardiac Surgery, The Children’s Hospital, Boston, Massachusetts, USA
b Department of Cardiology, The Children’s Hospital, Boston, Massachusetts, USA
c Department of Biostatistics, The Children’s Hospital, Boston, Massachusetts, USA
Accepted for publication November 6, 2000.
Address reprint requests to Dr Bacha, Pediatric Cardiac Surgery, Section of Cardiac and Thoracic Surgery, MC 5040, The University of Chicago Children’s Hospital, 5841 Maryland Ave, Chicago, IL 60637
e-mail: ebacha{at}surgery.bsd.uchicago.edu
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.
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