Long-term outcomes of surgical correction of aortic coarctation in newborns: a pilot prospective two-center study

Introduction. Resection of the narrowed aortic segment is the treatment of choice for coarctation of the aorta in newborns, but the issue of recurrent coarctation remains relevant (26% of cases in the long term period). The question of the optimal patch type and the necessity of ductal tissue removal remains open. Aim: To assess the long-term outcomes of surgical treatment of coarctation of the aorta in newborns using patches and native tissue on the aortic arch. Material and Methods . The study included 105 newborns that underwent surgeries from 2017 to 2023 at the Federal Center for Cardiovascular Surgery (Krasnoyarsk) and Meshalkin National Medical Research Center (Novosibirsk). Three methods were used: arch reconstruction with patch plasty also known as “Norwood Type” (“NP group”), resection with patch plasty (“RPP group”), and resection with end-to-end anastomosis (“REtEA group”). The gradient across the aortic arch was assessed echocardiographically at 6, 12 and 60 months (recoarctation criterion: gradient > 20 mm Hg). Results. The peak gradient at the isthmus did not differ at 6 and 12 months. Differences were noted during 60 months: in the “Norwood Type” group 18.0 [18.25; 24.25], in the “RPP” group 15.0 [13.13; 21.25], and in the “REtEA” group 13.5 [8.75; 18.62]. The reoperation risk in the “NT” group was 13.3%, higher than in other groups (3.4% and 0%). Conclusions. Ductal tissue excision and arch enlargement reduce the risk of recoarctation. A residual pressure gradient greater than 23 mm Hg at discharge is a predictor of restenosis.