Incidence and Risk Factors of Recoarctation Following Surgical Repair of Aortic Coarctation in Infants: A retrospective single-centre study

Abstract

Objectives: The reported incidence and risk factors for aortic recoarctation (reCoA) after surgical repair in infants vary widely. This study aimed to determine the incidence of reCoA and to identify associated risk factors in a cohort of infants. Secondary objectives included assessing parameters associated with reintervention. Methods: This retrospective cohort study was conducted at the National Heart Center, Muscat, Oman, and included all infants who underwent surgical repair of coarctation of the aorta (CoA) from January 2016 to December 2022. Preoperative, intraoperative and postoperative data were collected, including demographics, prostaglandin E2 use, surgical technique and echocardiographic measurements. Recoarctation was defined as requiring surgical or catheter-based reintervention within the follow-up period. Results: A total of 113 infants were included in this study. The incidence of reCoA was 23%. Affected patients were significantly younger (P = 0.002) and had lower body weight (P = 0.012) than those without reCoA. Dysmorphic features were more prevalent in the reCoA group (P = 0.042). End-to-end anastomosis was more frequent in the non-reCoA group, whereas bovine patch augmentation was significantly more common in the reCoA group (P = 0.006). Among patients requiring cardiopulmonary bypass, the reCoA group had significantly shorter aortic cross-clamp times (P = 0.014). Echocardiographic analysis revealed smaller transverse aortic arch (P = 0.019) and aortic isthmus (P = 0.018) measurements in the reCoA group. Multivariate analysis identified low surgical weight (odds ratio [OR] = 0.085, 95% confidence interval [CI]: 0.008–0.898; P = 0.047) and bovine patch use (OR = 5.35, 95% CI: 0.688–119; P = 0.048) as independent predictors. Conclusions: Low body weight at surgery, use of bovine patch augmentation and smaller aortic arch dimensions are significant risk factors for reCoA in infants. These findings emphasise the importance of individualised surgical planning and rigorous postoperative monitoring.