Impact of Surgical Strategy and Post-Repair Transverse Aortic Arch Size on Late Hypertension After Coarctation Repair During Infancy.

OBJECTIVE: Late HTN after CoA repair contributes to higher morbidity and mortality. An association between TAA hypoplasia and HTN has been found, but its relationship with surgical strategy is unclear. We studied the association between late HTN and initial surgical strategy pertaining to the TAA.

METHODS: We retrospectively reviewed patients who underwent surgical repair of CoA during infancy with at least 10 years follow-up, excluding those with atypical coarctation, major associated heart defects, and residual isthmic narrowing. TAA diameter z-score immediately post-repair was measured as a marker of surgical strategy. Systemic HTN at latest follow-up was assessed using standard criteria.

RESULTS: A total of 130 patients underwent surgical repair of CoA (76% via thoracotomy, 24% via sternotomy; type of repair - resection and end-to-end anastomosis 62%, extended end-to-end anastomosis 30%, subclavian flap 5%, arch repair with patch 4%), at a median age of 14 (IQR 7-62) days. Median post-repair TAA diameter z-score was -2.04 (IQR -2.69, 1.24). After a mean follow-up of 17.3 years, 43/130 (33%) patients developed HTN. After controlling for age at repair, gender, and presence of a genetic syndrome, HTN was not associated with immediate post-repair TAA diameter z-score, (p=0.41), type of surgical incision (p=0.99), or type of surgical repair (p=0.66).

CONCLUSIONS: In patients undergoing surgical repair of CoA during infancy, late HTN was not associated with immediate post-repair TAA size or surgical strategy pertaining to the TAA. These results suggest that factors other than surgical strategy, such as differential growth of the TAA during childhood, may be important.