• J. Thorac. Cardiovasc. Surg. · May 2023

    Growth of unrepaired hypoplastic proximal aortic arch and reintervention rate after aortic coarctation repair.

    • Antti Huuskonen, Lucy Hui, Kyle Runeckles, Wei Hui, David J Barron, Mark K Friedberg, and Osami Honjo.
    • Pediatric Cardiac and Transplantation Surgery Department, Helsinki Children's Hospital, University of Helsinki, Helsinki, Finland; Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada.
    • J. Thorac. Cardiovasc. Surg. 2023 May 1; 165 (5): 16311640.e11631-1640.e1.

    BackgroundTreatment of tubular hypoplasia of the aortic arch (THAA) associated with aortic coarctation (CoA) remains controversial. We aimed to evaluate growth of unrepaired hypoplastic proximal aortic arches (PAAs) after surgical repair for CoA.MethodsPreoperative and follow-up echocardiographic images of 139 patients who underwent CoA repairs from 2005 to 2012 were reviewed. THAA was defined as PAA z-score <-3 and non-THAA group z-score ≥-3. Reintervention rates due to aortic obstruction were assessed using competing risk models and diameters of the aorta were compared with Mann-Whitney U tests.ResultsFifty patients (36%) had THAA and 89 (64%) had non-THAA. The survival rate was 94% at 10 years. The overall reintervention rate at 10 years was 9% in the THAA group and 16% in the non-THAA group (P = .54). The catheter reintervention rate at ten years was 2% in the THAA group and 16% in the non-THAA group (P = .031). The surgical reintervention rate at ten years was 7% in the THAA group and 0% in the non-THAA group (P = .016). All 4 patients who required surgical reintervention were in the THAA group and 3 patients with PAA obstruction had preoperative PAA z-scores -3.6, -4.2, and -4.3. Follow-up echocardiograms showed PAA catch-up growth in the THAA group compared with the non-THAA group (preoperative z-score of -3.6 vs -2.3, and at 7 years of -1.1 vs -1.2; P < .001).ConclusionsUnrepaired PAA hypoplasia grows after CoA repair. Reintervention rates were comparable between groups but those with THAA had higher surgical reintervention rates.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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