{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:13:09Z","timestamp":1777878789511,"version":"3.51.4"},"reference-count":59,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Additional Ventures Catalyst to Independence Award"},{"name":"NIH","award":["T32HD104582"],"award-info":[{"award-number":["T32HD104582"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["World J Pediatr Congenit Heart Surg"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    The preferred surgical approach for aortic coarctation with hypoplastic aortic arch remains controversial. Perception exists that performing a sternotomy imposes a significant recovery burden. We analyzed perioperative outcomes of coarctation repair to compare approaches.\n                    <jats:bold>Methods:<\/jats:bold>\n                    Excluding genetic disorders and single-ventricle anatomy, 320 patients\u2009\u00b1\u2009hypoplastic arch underwent coarctation repair by thoracotomy (n\u2009=\u2009281) or sternotomy (n\u2009=\u200939) from 2012 to 2023 at median (IQR) age 22 days (7-383) and weight 3.9\u2005kg (3.2-9.0). Primary endpoints were postoperative intensive care unit (ICU) and hospital length of stay (LOS) and ventilation duration. Secondary outcomes included mortality and reintervention. Stratification by preoperative distal transverse arch (DTA) z-score was performed to assess the impact of arch hypoplasia on hospital course.\n                    <jats:bold>Results:<\/jats:bold>\n                    Sternotomy patients had longer median (IQR) ICU LOS (4.9 days [2.8-7.7] vs 2.0 days [1.3-3.3]), hospital LOS (11.3 days [6.1-16.3] vs 5.4 days [4.2-8.6]), and ventilation duration (2 days [1-4] vs 1 day [0-1]) than thoracotomy patients by 2.9, 5.9, and 1 day (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u2009.001 each). Thoracotomy patients had higher rates of antihypertensive medications at discharge (51% vs 33%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.042). At 2.2 years follow-up, there was one mortality. Although not statistically significant, of all reinterventions performed within each group, thoracotomy patients had a higher proportion within 90 days of repair (45% vs 0%,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.49); eight-year freedom from reintervention was 93.0% for sternotomy and 88.5% for thoracotomy (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.65). In a subgroup analysis of patients with DTA z-score\u2009\u2264\u2009\u22123, hospital LOS was similar between approaches (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.063).\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Children undergoing coarctation repair via sternotomy had a longer hospital course than those undergoing thoracotomy, although differences diminished among those with DTA z-score\u2009\u2264\u2009\u22123. Either approach can be considered in patients with mild-to-moderate arch hypoplasia given minor numeric differences in perioperative outcomes; however, sternotomy may provide more complete relief of obstruction to mitigate risks associated with residual elevated arch resistance.\n                  <\/jats:p>","DOI":"10.1177\/21501351251375456","type":"journal-article","created":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:41:07Z","timestamp":1761846067000},"page":"321-329","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Surgical Approach on Hospital Course After Repair of Aortic Coarctation With Arch Hypoplasia"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2306-6443","authenticated-orcid":false,"given":"Dominic P.","family":"Recco","sequence":"first","affiliation":[{"name":"Boston Children's Hospital"},{"name":"Department of Cardiology, Boston 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