Abstract 16723: Rates of Interventions Post Coarctation Repair in Neonates Versus Infants: Does Age Matter?
Introduction: Conflicting reports exist about the timing of coarctation (CoA) repair and rate of subsequent interventions on the CoA site and other left sided structures (LSS).
Hypothesis: There will be no difference in post-discharge interventions (post-DCI) between neonates and infants following isolated CoA repair.
Methods: Retrospective review of neonates (≤30 days) and infants (1-6 months) with isolated CoA undergoing repair (via thoracotomy) between 2000 and 2016. Clinical and echocardiographic data including preoperative Z scores of aortic valve, arch and isthmus were reviewed. Postoperative length of stay (intensive care [PICULOS]; hospital [PHLOS]), and post-DCI on CoA and LSS (mitral valve/LVOT/aortic valve) were compared between groups. Linear/Cox regression was used to determine predictors of post-DCI and LOS for the entire cohort.
Results: There were 213 (71.5%) neonates and 85 (28.5%) infants. Mean follow up was 3 (IQR 0.2, 9) years. There was no difference in post-DCI on CoA (10.3% vs. 4.7%; p=0.1) or LSS (9.9% vs. 9.4%; p=0.9); figure. Median PICULOS (3.01 vs. 2.28 days, p<0.001) and PHLOS (6.23 vs. 4.85 days, p<0.001) was higher in neonates versus infants. On multivariable modeling preoperative left sided catheter intervention, left sided obstructive lesions, and hypoplastic aortic arch predicted post-DCI on CoA or LSS. Age and genetic abnormality predicted prolonged PICULOS and PHLOS (table). On comparing preoperative aortic valve, transverse arch and isthmus Z scores between those with and without post-DCI, preoperative aortic valve Z score was associated with post-DCI on LSS [-2.05(-2.88, -1.28) vs. -1.56 (-2.19, -0.72); p=0.001).
Conclusions: Coarctation repairs can be safely performed in infants and neonates with acceptable post-DC intervention on CoA and other LSS. Weight and age should not be considered a contraindication to early repair. Preoperative aortic valve Z score may be an important discriminator for interventions on LSS.
Author Disclosures: R. IJsselhof: None. H. Liu: None. F. Pigula: None. J. Mayer: Consultant/Advisory Board; Modest; Medtronic Transcatheter Native Pulmonary Valve Data Safety and Monitoring Board. P. del Nido: None. M. Nathan: None.
- © 2016 by American Heart Association, Inc.