Contemporary Practice of Native Coarctation in Children Greater Than One Year of Age: A Society of Thoracic Surgeons Analysis

Objective Limited data exist on surgical repairs for native coarctation of the aorta (Native-CoA) after year-one of life. We sought to establish surgical outcomes benchmark of older Native-CoA repair patients. Methods All patients greater than one year of age who underwent off-pump Native-CoA repair were identified from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) between January 1998 and December 2022. Results A total of 2,898 patients older than one year (mean age: 6.1 years; mean weight: 23.7 kg) underwent Native-CoA repair through left thoracotomy at 131 STS-CHSD centers. Vascular syndromes including Turners, Williams, and Alagille, were relatively rare at 1.8%. The most common procedures were extended end-to-end (1,309/2898, 45.2%) end-to-end 1,107/2898, (38.2%), and patch aortoplasty ((239/2898, 8.2%). From 1998 to 2018, there was an overall increase in the number of patients (14 vs 156), explained largely by the increased number of hospitals (4 vs 70). However, after 2018, case counts declined by nearly 50%. Operative mortality was rare (n = 3). An average of 1.2 complications per patient (438 total) occurred in 365/2898 (12.6%) patients. The most common complications included chylothorax (101/2898, 3.5%), unplanned 30-day readmission (28/1917, 1.5%), and arrhythmia requiring drug therapy (17/1917, 0.9%). Median length of hospital stay was four days, with hospital stay >6 days in 248 patients (14.8%). Conclusions Frequency of off-pump Native-CoA repairs (age >1 year) is decreasing despite no notable change in total participating hospitals and case counts. This is likely due to increased percutaneous interventions despite very low documented mortality and morbidity of off-pump surgical repairs.