Deciphering risk elements: exploring precursors to recoarctation in individuals with aortic coarctation

Introduction
Coarctation of the aorta (CoA) patients often experience recoarctation, the reoccurrence of aortic narrowing, presenting a considerable clinical challenge.

Aim
This study aims to investigate the triggers or contributing factors associated with the development of recoarctation (reCoA) following the initial repair of CoA.

Material and methods
The retrospective cohort study includes information about 120 patients, who underwent 4 different types of surgical repairs of coarctation of the aorta through left thoracotomy in the period 2012–2022. Recoarctation was evaluated using the pressure gradient on the coarctation site measured by echocardiography (echoCG). A threshold of more than 20 mm Hg was employed to define recoarctation. All statistical analysis was performed using SPSS and Jamovi applications.

Results
The study revealed that 30 (25%) patients experienced early recoarctation, while 52 (43.7%) patients encountered late recoarctation. Among the 28 (23.3%) patients who had arch hypoplasia, 12 experienced early recoarctation, and 22 exhibited late recoarctation. Correlation tests demonstrated a strong negative correlation of the z-score of the arch size with both early recoarctation (r = –0.229, p = 0.013) and late recoarctation (r = –0.421, p < 0.001). Resection and end-to-end anastomosis (EEA) displayed the highest proportions of early (59%) and late (77%) recoarctation.

Conclusions
Aortic arch hypoplasia emerges as a significant risk factor for both early and late recoarctation. Additionally, while all coarctation repair methods carry some risk of recoarctation, resection and end-to-end anastomosis and prosthetic patch aortoplasty may pose a higher risk compared to extended end-to-end anastomosis.