Among congenital heart diseases, aortic coarctation accounts for 5–8% of patients and is associated with significant morbidity and mortality from childhood to adulthood. Neonatal forms are considered critical congenital heart defects, requiring early management under optimal conditions to ensure a favorable cardiovascular prognosis. Among postoperative complications, aortic recoarctation is the most frequent early complication in these patients. However, to date, the predictive factors for this complication remain poorly understood. The objective of this multicenter study is to describe the morbidity and mortality of aortic coarctation operated on before 1 year of age in a large multicenter cohort and to identify predictive factors for aortic recoarctation.

This is a retrospective, multicenter, longitudinal observational study conducted in five French surgical centers. Patients who underwent surgery for aortic coarctation before the age of one year, between January 2011 and December 2025, were included. Patients with complex congenital heart disease and those who initially underwent cardiac catheterization were excluded. The primary endpoint was 6-year survival free from aortic recoarctation. Secondary endpoints were overall survival and survival free from arterial hypertension.

A total of 908 patients were included (male-to-female ratio: 1.95), with a median follow-up of 4 years. The median age at surgery was 14 days. The surgical technique used was the Crafoord procedure in 35% of cases, extended Crafoord repair in 48%, and aortic arch plasty in 17%. Survival free from recoarctation was 81.5% at 6 years ( Fig. 1 ). Overall survival was 97% at 6 years. Survival free from hypertension was 60% at 6 years. Predictive factors for recoarctation identified in univariate analysis included demographic, clinical, and imaging outcomes. Multivariate analysis is ongoing.

Neonatal aortic coarctation remains a condition associated with substantial morbidity and mortality. The predictive factors for recoarctation identified may help guide surgical decision-making and follow-up strategies. Hypertension remains the main long-term morbidity, affecting up to 40% of children at 6 years of age, although only 8.5% receive treatment. Improving its detection and management is essential to reduce long-term cardiovascular impact in adulthood.