Deciphering risk elements: exploring precursors to recoarctation in individuals with aortic coarctation.

Abstract

Introduction: Coarctation of the aorta (CoA) patients often experience recoarctation, the reoccurrence of aortic narrowing, presenting a considerable clinical challenge.

Aim: This study aims to investigate the triggers or contributing factors associated with the development of recoarctation (reCoA) following the initial repair of CoA.

Material and methods: The retrospective cohort study includes information about 120 patients, who underwent 4 different types of surgical repairs of coarctation of the aorta through left thoracotomy in the period 2012-2022. Recoarctation was evaluated using the pressure gradient on the coarctation site measured by echocardiography (echoCG). A threshold of more than 20 mm Hg was employed to define recoarctation. All statistical analysis was performed using SPSS and Jamovi applications.

Results: The study revealed that 30 (25%) patients experienced early recoarctation, while 52 (43.7%) patients encountered late recoarctation. Among the 28 (23.3%) patients who had arch hypoplasia, 12 experienced early recoarctation, and 22 exhibited late recoarctation. Correlation tests demonstrated a strong negative correlation of the z-score of the arch size with both early recoarctation (r = -0.229, p = 0.013) and late recoarctation (r = -0.421, p < 0.001). Resection and end-to-end anastomosis (EEA) displayed the highest proportions of early (59%) and late (77%) recoarctation.

Conclusions: Aortic arch hypoplasia emerges as a significant risk factor for both early and late recoarctation. Additionally, while all coarctation repair methods carry some risk of recoarctation, resection and end-to-end anastomosis and prosthetic patch aortoplasty may pose a higher risk compared to extended end-to-end anastomosis.