Management of Ductus-Dependent Systemic Circulatory Lesions in the Neonatal Period: A Ten-Year Experience

Abstract

Background: In ductus-dependent left-sided heart lesions, systemic circulation depends on right-to-left flow via the ductus arteriosus. These lesions may occur as an isolated defect or complex disease. Objective: In this study, we aimed to investigate the neonatal outcomes of duct-dependent systemic circulatory lesions, especially aortic coarctation (CoA) and interrupted aortic arch (IAA). Methods: A total of 159 patients with duct-dependent systemic lesions were followed up in the Cardiac NICU of our institution from 2012 to 2022. We retrospectively reviewed the medical charts of all patients from the hospital database. They were analyzed for clinical and surgical outcomes. A p-value of <0.05 was considered statistically significant. Results: Of 159 patients, CoA was detected in 120 (75.4%) and IAA in 39 (24.5%) patients. Cardiac catheterization was performed in 74 (61.6%) patients with CoA in the neonatal period; 49 (40.8%) underwent therapeutic and 25 (20.8%) diagnostic procedures. One hundred one patients with CoA (84.1%) underwent surgery at a median age of 14 days (9-23). Thirty-four of 39 patients with IAA (87.1%) underwent surgery; single-stage repair was performed on 13 patients (38.2%), while two-stage repair was applied to 21 (61.7%) patients. The overall neonatal mortality rate was 19.5% (n=31). In multivariate analysis, the higher STAT categories (OR:2.3, CI:95%, 1.1-5.1, p=0.03) and the presence of major postoperative complications (OR:9.8, CI:95%, 2.1-35.1, p=0.003) have increased the risk of neonatal mortality. Conclusion: Newborns with congenital duct-dependent aortic anomalies necessitate meticulous perioperative care due to their heightened risk of morbidity and mortality.