Predictive factors of surgical repair technique in infants with coarctation of the aorta

7 août 2025

Eur Heart J Qual Care Clin Outcomes. 2025 Aug 7:qcaf074. doi: 10.1093/ehjqcco/qcaf074. Online ahead of print.

Oscar Werner^{1 2}, Marion Pouzenc^{1 2}, Helena Huguet³, Bertrand Leobon^{4 5}, Marie-Christine Picot^{3 6}, Gregoire De La Villeon^{1 2}, Marie Vincenti^{1 2}, Alban-Elouen Baruteau^{7 8 9 10}, Mohamed Ly⁷, Caroline Ovaert^{11 12}, Virginie Fouilloux¹¹, Philippe Acar¹³, Clement Karsenty¹³, François Roubertie^{4 5}, Jean-Benoit Thambo^{4 5}, Sophie Guillaumont^{1 2}, Pascal Amedro^{4 5}

PMID: 40795268 DOI: 10.1093/ehjqcco/qcaf074

Abstract

Objectives: Coarctation of the aorta (CoA) is the most common undiagnosed congenital heart disease during prenatal screening and its overall prognosis relies on the quality of the surgical repair. This study aimed to identify the prenatal and postnatal factors associated with the type of surgical technique repair in infant CoA.

Methods: Multicentre, retrospective, observational study in 680 infants (68% males) aged <1 year who underwent CoA surgical repair in 4 CHD surgical centres in France over 11 years. The primary outcome was the surgical repair technique (simple end-to-end repair, extended end-to-end repair, or aortic arch repair).

Results: The aortic arch raw diameter, measured by echocardiography just beyond the brachiocephalic arterial trunk, was the most discriminating parameter for the type of surgical repair technique, outperforming the existing Z-scores models. Cut-off value of aortic arch diameter ≤3.6 mm in children < 1 years old was predictive of an aortic arch repair (area under the curve (AUC) [95%CI]=0.76 [0.67;0.86]). In multivariable analysis, a prenatal associated cardiac malformation (odd ratio (OR)[95%CI]=4.39 [1.99 ; 9.69]) and aortic arch diameter ≤3.6mm (OR[95%CI]=3.78 [1.61 ; 8.62]) were predictive of an aortic arch repair.

Conclusion: The aortic arch diameter is the most discriminating parameter for the type of surgical repair technique in infant CoA. An aortic arch threshold value of 3.6 mm in infant population is predictive of aortic arch repair and should be considered a practical indicator of the hypoplastic nature of the aortic arch.

Keywords: CT angiography; Z-score; aortic arch hypoplasia; aortic coarctation; congenital heart disease.

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