Outcomes after primary surgical repair of coarctation of the aorta through lateral thoracotomy.

INTRODUCTION AND

OBJECTIVES

Simple coarctation of the aorta (CoA) can be repaired through left lateral thoracotomy without cardiopulmonary bypass. However, late adverse events such as death, restenosis, aneurysm formation, and development of hypertension can occur, even after initial successful repair. In this study, we evaluated outcomes after surgical repair of CoA through left lateral thoracotomy and examined risk factors for adverse events.

METHODS

Among 986 patients who underwent CoA repair at our institution from 2001 to 2023, we selected patients repaired through left lateral thoracotomy and excluded those with univentricular circulation. Surgical outcomes were evaluated using cumulative incidence curves, and risk factors were analyzed using Cox regression models.

RESULTS

A total of 401 patients were included; 138 (34.4%) were female and 56.6% had isolated CoA. Median age at surgery was 30 days. During a median follow-up of 10.3 years (interquartile range, 3.3-17.8 years), overall survival exceeded 98% at 20 years. Reoperation was required in 4.5% of patients and catheter-based reintervention in 9.7%, both after a median of approximately 10 years. Ventricular septal defect, associated heart defects, and patch plasty were associated with increased mortality. Older age at repair, prematurity, subaortic stenosis, prosthesis implantation, and associated cardiac anomalies were associated with an increased risk of reoperation, while hypoplastic aortic arch and repair in the neonatal period increased the risk of catheter-based reintervention.

CONCLUSIONS

Survival after lateral thoracotomy repair of aortic coarctation is excellent. However, late adverse events are influenced by anatomical complexity and patient-related factors, underscoring the need for structured lifelong follow-up.