Repair of aortic coarctation in neonates less than two kilograms

Objectives: A significant number of low-birth-weight neonates are born with aortic coarctation. Previous studies of early operation on these patients have shown a high hospital mortality and recurrence at 1 year. We reviewed our data to ascertain whether modern approaches allow better outcomes for these children.

Methods: Fourteen patients weighing <2 kg with isolated coarctation between January 2005 and December 2015 were studied by retrospective chart review to ensure >5 years follow-up. All patients underwent extended end-to-side surgical repair. In-hospital and medium-term follow-up data were collected. Data are expressed as median (range).

Results: Weight at the time of surgery was 1.8 (1.5-1.9) kg. There were no deaths, in-hospital or during follow-up. In-hospital stay was 11 (4-47) days. At follow-up of 141 (80-207) months echocardiographic velocity across the repair was 1.6 (0.9-3.8) m/s. Two patients required balloon dilatations for recoarctation including 1 with William's syndrome who required balloon coarctoplasty followed by stenting. This patient had grossly abnormal vessels at the time of initial surgery with aortic wall thickness >3 mm. There were no central neurological complications. Other complications included vocal cord dysfunction in 1, development of chylothorax requiring prolonged chest drainage in 2, pneumothorax following chest drain removal in 1 and wound dehiscence in 1 patient.

Conclusions: Neonates below 2 kg can undergo coarctation repair safely with low incidence of recurrence. Waiting for growth in this cohort of patients may not therefore be justified.