The main challenge of aortic coarctation repair in infants is to obtain durable results without morbidity.

We aimed to describe predictors of mortality and of arch aortic re-intervention after aortic coarctation repair.

Between January 2000 and March 2014, we retrospectively included consecutive infants with isolated coarctation or coarctation with ventricular septal defect (CoA+VSD) who had surgical repair of the aortic arch before three months of age.

Five hundred and thirty patients were included: 308 (58%) patients had isolated coarctation and 222 (42%) had CoA+VSD. Three hundred and eighty-five (72.6%) only had coarctation repair, 51 patients (9.6%) had coarctation repair with closure of VSD, and 94 patients (17.8%) had coarctation repair and pulmonary artery banding. Mean age at operation was 13±1.6 days. Mean weight at repair was 3.2±0.75kg. Median follow-up was 7.57 [0.25–15.98] years.

Sixty-one patients (11.5%) needed reintervention on the aortic arch (surgery or endovascular interventions). Freedom from aortic arch reintervention was 90% at one year, and 88.5% at five years. Rates of aortic arch reintervention were similar in the different surgical strategy groups (P=0.80). However, in patients receiving prostaglandin E1 (PGE1), the end-to-end repair was at higher risk of re-coarctation compared to the extended end-to-side repair (P=0.0081). The risk factors of aortic arch reintervention were age at repair<15 days (P=0.032), and the need for PGE1 infusion at surgery (P=0.0072).

Overall mortality was 3.6% (19 patients) without significant difference between surgical strategies (P=0.078). In multivariate analysis, the risk factors of death were the presence of VSD (P=0.037), and low weight at surgery (P=0.001).

The use of PGE1 may modify the aortic arch anatomy and mask the boundaries of the resection to be performed. Strategies to improve the surgical strategy preoperatively should be developed.