Exploring precipitants of re-coarctation in coarctation of the aorta patients

Objective: Coarctation of the aorta (CoA) is a congenital heart defect characterized by a narrowing of the aorta, often necessitating surgical repair to restore normal blood flow. Despite successful initial interventions, a significant subset of patients experiences recoarctation (re-CoA), the reoccurrence of aortic narrowing, presenting a considerable clinical challenge. This study aims to investigate the triggers or contributing factors associated with the development of re-CoA following the initial repair of CoA, to identify potential strategies for its prevention and management. Methods: A retrospective cohort study includes information about 120 patients, who underwent 4 different types of surgical repairs of CoA through left thoracotomy between 2012-2022. Recoarctation was evaluated using the pressure gradient on the coarctation site measured by echocardiography. A threshold of more than 20mmHg was employed to define recoarctation. All statistical analysis was performed using SPSS software. Results: The study revealed that 30 patients (25%) experienced early recoarctation, while 52 patients (43.7%) encountered late recoarctation. Patient-related variables such as age, height, weight, gender, and body mass index (BMI) were not correlated with early or late recoarctation. Among the 28 patients (23.3%) who had arch hypoplasia, 12 of them experienced early recoarctation, and 22 of them 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. Prosthetic patch aortoplasty (PPA) showed a relatively higher rate of recoarctation, with 27% of patients experiencing early recoarctation and 44% exhibiting late recoarctation. Resection and extended end-to-end anastomosis displayed a comparatively lower rate, with 0% experiencing early recoarctation and 23% exhibiting late recoarctation. Conclusion: Aortic arch hypoplasia emerges as a significant 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. Recognizing these factors is crucial for optimizing surgical outcomes and reducing recoarctation incidence in patients with coarctation of the aorta.

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