Unraveling Risk Factors: Investigating Triggers for Recoarctation in Patients with Coarctation of the Aorta
Abstract:
Introduction: 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 patient’s experiences recoarctation, 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 recoarctation (reCoA) following the initial repair of coarctation of the aorta (CoA), to identify potential strategies for its prevention and management.
Materials and Methods: A retrospective cohort study includes information about 120 patients, who underwent 4 different types of surgical repairs of coarctation of aorta through left thoracotomy between 2012-2022. Recoarctation was evaluated using the pressure gradient on the coarctation site measured by echocardiography (echoCG). A threshold of more than 20mmHg was employed to define recoarctation. All statistical analysis was performed using SPSS and Jamovi applications.
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 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: patient-related variables like age, height, weight, gender, and BMI may not directly cause early or late recoarctation. However, aortic arch hypoplasia emerges as a significant risk 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.
