Neonatal coarctation of the aorta: A 10 years observational study to identify influencing factor of the technique of surgery

Introduction

Coarctation of the aorta is one of the most common congenital heart diseases (5–8%) with various clinical presentations (neonatal vs. pediatric, with or without cardiac insufficiency). On a surgical point of view, there are many different techniques that will take into account the anatomy of the aortic arch and whether or not it is hypoplastic, the associated heart defect and the patient's characteristics. The choice of this surgical technique is one of the predominant elements of the future prognosis (recoarctation, arterial hypertension). However, the choice of the surgeon whether to treat or not the aortic arch with an extended plasty is not very codified as the definition of hypoplasia itself can be discussed. Moreover there is a need to evaluate the contribution of different imaging techniques into the decision making process. This retrospective multicentric study intends to assess the potential influencing factors of the type of surgery and to make an epidemiological description of neonatal coarctation.

Methods

Retrospective multicentric observational study including patients of less than 1 years-old operated of coarctation of the aorta between 2011 and 2021 in four surgical centers in south France.

Results/Expected results

In total, 686 patients included. 43% of antenatal diagnosis; Sex ratio M/F: 68/32%; 6% of genetic test positive; the global mortality rate was 3%. 23% of patients presented cardiac insufficiency at diagnosis. Prostaglandin perfusion was necessary in 58% of cases. In echocardiography, an aortic arch hypoplasia was described between 53–57% of cases, depending of analysis method. A CT angiography was performed in 19% of patients with 58% of hypoplasia described. Concerning surgery, an aortic arch plasty was performed in only 18% of patients. The main predictors of surgical technique was antenatal screening, cardiac malformations associated, use of prostin, the horizontal aortic size, mitral hypoplasia. Standard deviation was not significant.

Conclusion/Perspectives

These preliminary results give an interesting view of the epidemiology of coarctation in France. Further extended data will be presented.