Download PDF
Thorac Cardiovasc Surg 2022; 70(01): 026-032
DOI: 10.1055/s-0041-1731825
Original Cardiovascular

Outcomes of Arch Reintervention for Recurrent Coarctation in Young Children

Qi Jiang
1   Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
,
Renjie Hu
1   Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
,
Wei Dong
1   Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
,
Ying Guo
1   Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
,
Wen Zhang
1   Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
,
Jie Hu
1   Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
,
Haibo Zhang
1   Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
› Author Affiliations Funding Health and Family Planning Committee of Pudong New Area (grant no. PWZxq2017-14) and Shanghai Jude Charity Foundation.
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Objectives To evaluate the outcomes of reintervention for postrepair recoarctation in young children.

Methods Between January 2011 and December 2020, all consecutive patients aged ≤3 years who were treated for postrepair recoarctation were included. Recoarctations were classified into two morphological types by three-dimensional imaging. Two methods, namely, surgical repair and balloon angioplasty (BA), were used to treat recoarctation.

Results This study included 50 patients with a median age of 10.5 months (range, 2.0–36.0 months) and a mean weight of 9.3 ± 3.1 kg. Hypoplastic recoarctation occurred most frequently in patients who had undergone patch aortoplasty at initial repair (p = 0.001). No hospital mortality occurred, and all patients achieved an increased diameter (p < 0.001) and a decreased pressure gradient (p < 0.001) at the recoarctation site immediately after reintervention. The median follow-up time after reintervention was 3.5 years (range, 16.0 days–9.6 years). Late mortality occurred in four patients (8.0%): two in the surgical group and two in the BA group (chi-square test= 0.414, p = 0.520). There was no difference in arch reobstruction after reintervention between the surgical and BA groups (chi-square test = 1.383, p = 0.240). Recoarctation with a hypoplastic morphology was the leading risk factor for arch reobstruction after reintervention (hazard ratio, 6.552; 95% confidence interval, 2.045–20.992; p = 0.002).

Conclusion Reintervention for recoarctation has favorable early outcomes in young children. However, late mortality is not rare, and arch reobstruction is common during close follow-up. For young children, recoarctation with hypoplastic morphology is the leading risk factor for reobstruction, while the choice of reintervention method exerts little effect on the outcomes of arch reintervention.

Keywords

cardiac - catheterization/intervention - aorta/aortic - outcomes - stenosis - surgery - complications

Supplementary Material



Publication History

Received: 14 January 2021

Accepted: 15 May 2021

Article published online:
14 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 IJsselhof R, Liu H, Pigula F. et al. Rates of Interventions in isolated coarctation repair in neonates versus infants: does age matter?. Ann Thorac Surg 2019; 107 (01) 180-186
    CrossrefPubMedSearch in Google Scholar
  • 2 Seo DM, Park J, Goo HW, Kim YH, Ko JK, Jhang WK. Surgical modification for preventing a gothic arch after aortic arch repair without the use of foreign material. Interact Cardiovasc Thorac Surg 2015; 20 (04) 504-509
    CrossrefPubMedSearch in Google Scholar
  • 3 Tulzer A, Mair R, Kreuzer M, Tulzer G. Outcome of aortic arch reconstruction in infants with coarctation: importance of operative approach. J Thorac Cardiovasc Surg 2016; 152 (06) 1506-1513.e1
    CrossrefPubMedSearch in Google Scholar
  • 4 Mery CM, Guzmán-Pruneda FA, Carberry KE. et al. Aortic arch advancement for aortic coarctation and hypoplastic aortic arch in neonates and infants. Ann Thorac Surg 2014; 98 (02) 625-633 , discussion 633
    CrossrefPubMedSearch in Google Scholar
  • 5 Gray WH, Wells WJ, Starnes VA, Kumar SR. Arch augmentation via median sternotomy for coarctation of aorta with proximal arch hypoplasia. Ann Thorac Surg 2018; 106 (04) 1214-1219
    CrossrefPubMedSearch in Google Scholar
  • 6 Turek JW, Conway BD, Cavanaugh NB. et al. Bovine arch anatomy influences recoarctation rates in the era of the extended end-to-end anastomosis. J Thorac Cardiovasc Surg 2018; 155 (03) 1178-1183
    CrossrefPubMedSearch in Google Scholar
  • 7 Lee MGY, Allen SL, Koleff J. et al. Impact of arch reobstruction and early hypertension on late hypertension after coarctation repair. Eur J Cardiothorac Surg 2018; 53 (03) 531-537
    CrossrefPubMedSearch in Google Scholar
  • 8 Wong JSY, Lee MGY, Brink J, Konstantinov IE, Brizard CP, d'Udekem Y. Are more extensive procedures warranted at the time of aortic arch reoperation?. Eur J Cardiothorac Surg 2017; 52 (06) 1132-1138
    PubMedSearch in Google Scholar
  • 9 Brown JW, Ruzmetov M, Hoyer MH, Rodefeld MD, Turrentine MW. Recurrent coarctation: is surgical repair of recurrent coarctation of the aorta safe and effective?. Ann Thorac Surg 2009; 88 (06) 1923-1930 , discussion 1930–1931
    CrossrefPubMedSearch in Google Scholar
  • 10 Luijendijk P, Bouma BJ, Groenink M. et al. Surgical versus percutaneous treatment of aortic coarctation: new standards in an era of transcatheter repair. Expert Rev Cardiovasc Ther 2012; 10 (12) 1517-1531
    CrossrefPubMedSearch in Google Scholar
  • 11 Gendera K, Ewert P, Tanase D. et al. Balloon-expandable stents for recoarctation of the aorta in small children. Two centre experience. Int J Cardiol 2018; 263: 34-39
    CrossrefPubMedSearch in Google Scholar
  • 12 Feltes TF, Bacha E, Beekman III RH. et al; American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Radiology and Intervention, American Heart Association. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123 (22) 2607-2652
    CrossrefPubMedSearch in Google Scholar
  • 13 Reich O, Tax P, Bartáková H. et al. Long-term (up to 20 years) results of percutaneous balloon angioplasty of recurrent aortic coarctation without use of stents. Eur Heart J 2008; 29 (16) 2042-2048
    CrossrefPubMedSearch in Google Scholar
  • 14 Brown ML, Burkhart HM, Connolly HM, Dearani JA, Hagler DJ, Schaff HV. Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation 2010; 122 (11, Suppl): S81-S84
    CrossrefPubMedSearch in Google Scholar
  • 15 Tong F, Li ZQ, Li L. et al. The follow-up surgical results of coarctation of the aorta procedures in a cohort of Chinese children from a single institution. Heart Lung Circ 2014; 23 (04) 339-346
    CrossrefPubMedSearch in Google Scholar
  • 16 Bechtold C, Purbojo A, Schwitulla J. et al. Aortic arch reconstruction in neonates with biventricular morphology: increased risk for development of recoarctation by use of autologous pericardium. Thorac Cardiovasc Surg 2015; 63 (05) 373-379
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Herzog S, Dave H, Schweiger M. et al. Effectiveness of balloon angioplasty in children with recurrent aortic coarctation depends on the type of aortic arch pathology. J Interv Cardiol 2016; 29 (04) 414-423
    CrossrefPubMedSearch in Google Scholar
  • 18 Christopher AB, Apfel A, Sun T, Kreutzer J, Ezon DS. Diastolic velocity half time is associated with aortic coarctation gradient at catheterization independent of echocardiographic and clinical blood pressure gradients. Congenit Heart Dis 2018; 13 (05) 713-720
    CrossrefPubMedSearch in Google Scholar
  • 19 Tretter JT, Jones TK, McElhinney DB. Aortic wall injury related to endovascular therapy for aortic coarctation. Circ Cardiovasc Interv 2015; 8 (09) e002840
    CrossrefPubMedSearch in Google Scholar
  • 20 Yetman AT, Nykanen D, McCrindle BW. et al. Balloon angioplasty of recurrent coarctation: a 12-year review. J Am Coll Cardiol 1997; 30 (03) 811-816
    CrossrefPubMedSearch in Google Scholar
  • 21 Lefort B, Lachaud M, El Arid JM. et al. Immediate and midterm results of balloon angioplasty for recurrent aortic coarctation in children aged<1 year. Arch Cardiovasc Dis 2018; 111 (03) 172-179
    CrossrefPubMedSearch in Google Scholar