Echocardiographic predictors of recoarctation following surgical repair – a Swedish national study

Background Following surgical repair of aortic coarctation (CoA) there is a risk for restenosis (reCoA), particularly in the first year of life. It was the aim of this study to identify reCoA risk factors by analyzing postoperative pre-discharge echocardiograms. Methods Retrospective analysis of echocardiograms of children born operated for CoA in Sweden 2011-2017. Results 253 children were included; median age at surgery 10 days; median follow-up 4.6 years. ReCoA occurred in 34 patients (13%; 74% by 6 months, 91% by 12 months). We generated two reCoA risk models applying a) aortic dimensions and b) the respective Z-scores combined with surgical and demographic factors. We defined reCoA risk categories as low (≤10%), moderate (11-29%), moderate-high (30-49%) and high (≥50%). Patients with a) isthmus ≤3.3mm (1- and 5-year event free survival 38 and 32%) or b) isthmus Z-score ≤-2.8 with a weight at surgery 3.7mm and distal aortic arch >3.5mm (1- and 5-year event free survival 97 and 97%), and b) isthmus and proximal aortic arch Z-score >-2.8 or operative weight >4.4kg with an isthmus Z-score <=-2.8 with (1- and 5-year event free survival 97 and 97%). Conclusion ReCoA risk can be predicted based on postoperative pre-discharge echocardiographic variables in combination with surgical and demographic factors. We suggest tailoring follow-up intervals individually according to the predicted reCoA risk