COMPARISON OF IMMEDIATE AND LONG-TERM RESULTS OF TREATMENT OF CRITICAL COARCTATION IN NEWBORNS: STENTING/PRIMARY SURGICAL CORRECTION

Highlights

Critical aortic coarctation (CoA) in newborns leads to severe pressure overload of the left ventricle (LV), myocardial damage, which is accompanied by a high risk of cardiogenic shock and sudden cardiac death. Palliative stenting of the aortic isthmus in critically ill newborns reduces the incidence of mortality in the hospital period and makes it possible to prepare the patient for radical surgical correction of the defect.

Aim. To compare immediate and long-term results of palliative stenting and surgical correction of critical aortic coarctation in newborns.

Methods. The single-center, retrospective study was conducted at the National Medical Research Center named after Academician E.N. Meshalkin. From 2008 to 2021, the Department of Congenital Heart Diseases performed surgical treatment of 85 patients with critical aortic coarctation. 11 patients were excluded from the study. All patients included in the study (74 patients) were divided into two groups: palliative stenting (n = 20; 27%) and primary surgery (n = 54; 73%). After PSM analysis, the groups were balanced by age, weight, gender, body surface area and lactate. 40 patients were selected: 20 in each group. There were no significant differences between baseline characteristics between the groups.

Results. The technical success of aortic coarctation stenting was 100%. The lethal outcome in the stenting group was in 2 (10%) cases, while in the primary surgery group it was in 11 (55.5%) cases, p = 0.048. Complications in the early postoperative period were higher in the open surgery group. Long-term complications did not differ between groups and had an equal incidence of development.

Conclusions. Palliative stenting of critical aortic coarctation is associated with lower mortality during hospital stay compared with primary surgical correction (10% vs 55.5%, p = 0.048). Multiple organ failure in the early postoperative period is an independent risk factor (HR 102; 95% CI 3.5–295, p < 0.01) of death. Patients with critical aortic coarctation after primary surgical correction have a higher incidence of early postoperative complications in comparison with patients with palliative stenting (80% vs 40%, p = 0.02). The only risk factor for multiple organ failure (HR 22.8; 95% CI 4.1–302, p = 0.03) and/or acute renal failure (HR 17.6; 95% CI 1.3–238, p = 0.02) is primary surgical correction of the defect. The main risk factor for abdominal syndrome are patients operated with cardiopulmonary bypass (HR 19; 95% CI 4.8–280, p = 0.01). Long-term complications do not differ between groups and have an equal frequency of occurrence.

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