Surgical Treatment following Bail-Out Stenting for High-Risk Patients with Critical Neonatal Coarctation of the Aorta

Objectives: Coarctation of the aorta (CoA) in infants is usually treated by surgical repair. However, under certain high-risk constellations (cardiogenic shock, extracardiac comorbidities), primary bail-out stenting may be considered followed by surgical repair during the first months of life. We report our experience with this staged approach in 26 patients.

Methods: All patients who underwent surgical CoA repair after primary stenting at our institution between 2011 and 2019 were included in this retrospective analysis. Patient characteristics and outcomes were analyzed.

Result: Twenty-six neonates with critical CoA received a stent implantation (median length: 12 mm) at a median age of 21 days (IQR: 9–30 days). Subsequent surgical repair was conducted at an age of 3.0 months (IQR: 2.5–4.0 months) with a median body weight of 5.6 kg (IQR: 4.5–6.5 kg). Cardiopulmonary bypass was applied in 96% of cases. Median bypass time was 99 min (IQR: 86–112 min). Extended end-to-end anastomosis was feasible in 11 patients. Extended aortic reconstruction with xenopericardial (n = 4) or autologous (n = 2) patch or homograft material (n = 9) was necessary in the remaining patients. In four patients, stent remnants needed to remain in situ. Postoperative ventilation duration was 1.0 day (IQR: 0.3–2.3) with an intensive care unit stay of 4.8 days (IQR: 3.9–6.8 days). The aortic peak velocity was reduced from preoperative 3.0 m/s (IQR: 2.6–3.4 m/s) to 2.1 m/s (IQR: 1.4–2.6 m/s). One fatality (3.8%) occurred 33 days postoperatively. At a median follow-up of 3.7 years, all remaining patients were alive. 20/25 patients (80%) were free from reintervention.

Conclusion: Neonatal bail-out stenting for CoA results in increased complexity of the subsequent surgical therapy. Nevertheless, this staged approach enables treatment of high-risk patients with an acceptable perioperative risk and good mid-term outcomes.

Publication History

Article published online:
19 February 2021