PRENATAL DIAGNOSIS IMPROVES THE PERIOPERATIVE CONDITION OF NEONATES REQUIRING SURGICAL INTERVENTION FOR COARCTATION BUT IS ASSOCIATED WITH LONGER PREOPERATIVE STAY

Neonates with critical coarctation of the aorta (CoA) may present in extremis if unrecognized. Prenatal diagnosis permits more appropriate early management of affected neonates. We sought to determine whether, as a consequence, prenatal diagnosis improves the preoperative condition and operative course associated with critical CoA (surgery at < 30 days). We hypothesized that prenatal diagnosis of CoA would be associated with both improved preoperative condition and shorter hospital stay than postnatal diagnosis. We retrospectively compared the clinical presentation, preoperative condition and operative course of neonates prenatally (Group 1, G1) or only postnatally (Group 2, G2) diagnosed in Alberta from 2004 to 2015 with critical CoA. Cases with other left heart obstructive lesions and ventricular septal defects were included, but those with more complex heart disease were excluded. Preoperative data analysed included highest lactate and lowest arterial pH, highest creatinine and urea, the level of support required (use of inotropes, bicarbonate, oxygen, respiratory support), and pre and postoperative length of hospital stay (LOS). In total, 110 cases were included: G1-44 and G2-66. Age at surgery differed between groups (G1: median 7[1-30days] vs G2: 10 [1-30days] p = 0.05). Preoperatively, G2 had a greater incidence of metabolic acidosis with a pH < 7.29 in 5.1% vs 31% (p=0.002) and highest lactate >3.5 mmol/Lin 5.3% vs 25.5% (p=0.009) in G1 vs G2, respectively), and need for support including supplemental oxygen (24% vs 48%, G1 vs G2, respectively, p=0.028), and bicarbonate administration (0% vs 5%, G1 vs G2, p=0.001). A need for preoperative ventilation (43% vs 55%, G1 vs G2, respectively) and preop inotrope use (25.7% vs 38%) did not differ between groups. Total LOS was significantly longer in G1 patients (median 19.5 [5-72 days] vs G2 12.5 [4-58days] p=0.024) which was due to longer preoperative LOS (median 7 [1-22 days] vs 3 [0-25 days], G1 vs G2, respectively p < 0.001), as postoperative LOS did not differ. Prenatal diagnosis of critical CoA is associated with improved preoperative condition with reduced metabolic acidosis and the need for support; however, it is also associated with longer preoperative hospitalization. The factors responsible for lengthier preoperative stay among prenatally diagnosed cases are currently being explored to determine modifiable factors.