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Objective: For neonatal repair of coarctation of the aorta, patients may either undergo thoracotomy with extended end-to-end anastomosis or sternotomy for aortic arch reconstruction with cardiopulmonary bypass. The objective of this study was to evaluate the comparative effectiveness of the 2 approaches in patients with arch hypoplasia. Methods: This is a single-center retrospective cohort study from July 2005 through May 2022 of patients who underwent neonatal repair for isolated coarctation of the aorta with additional arch hypoplasia. Inverse probability of treatment weighting is a statistical method for creating comparable pseudopopulations and was used to account for baseline differences in population. The primary outcome was aortic reintervention, and secondary outcomes were vocal cord dysfunction, length of stay, chylothorax, and phrenic nerve palsy. Results: There were 130 patients who met inclusion criteria. After weighting, the interaction between distal transverse arch size and operative approach (sternotomy vs thoracotomy) was statistically significant, P

Spontaneous coronary artery dissection in infants is a rare phenomenon. We present 2 neonates with severe ventricular dysfunction due to coronary artery dissection. Neither patient had evidence of extracardiac fibromuscular dysplasia or other comorbidities that would explain the presentation. (Level of Difficulty: Advanced.)