Résumé
Background: coarctation of the aorta is a common congenital heart disease (CHD) affecting 5-8% of births. The choice of surgical technique, which condition the prognosis, depends on the presence of an aortic arch hypoplasia, associated cardiac lesions and the characteristics of the patient. Despite the improvement of imaging technics this surgical decision is often based on individual opinion and personal or institutional preference. This study aims to identify early predictors guiding surgical technique selection in coarctation cases under one year of age, aiding in improved decision-making.Methods: retrospective multicentric observational study including patients of less than 1 year of age operated for coarctation of the aorta between 2011 and 2021 in four surgical centres in France. The primary outcome was the surgical technique performed. Results: 680 patients were included. Predictive factors for aortic arch plasty vs. other surgeries were: associated cardiac malformation (OR: 3.43 CI [1.92; 6.13]), hemodynamic failure (OR: 1.82 CI [1; 3.3]), arch hypoplasia (OR: 1.78 CI [1.08; 2.93]), and a small left ventricle (OR: 2.71 CI [1.08; 6.79]). Significant differences were observed in the characterization of aortic hypoplasia: Z-scores were not discriminatory, whereas a specific absolute value cut-off for aortic arch (3.6) size was significant. (AUC: 0.75). Concordance between echocardiography and CT scan measurements was good.Conclusion: this multicenter retrospective study gives contemporary data on CoA in paediatric population. We highlighted severity predictors of CoA and the contradictory information that definitions of aortic arch hypoplasia. We proposed a potential cut-off of 3.6 mm as a good predictor of the surgical choice of aortic plasty. Finally, we discuss the use of CT-angiography and the need of clear guidelines on its use.