Is the medical treatment for arterial hypertension after primary aortic coarctation repair related to age at surgery? A retrospective cohort study

Lillitos, Peter J; Nassar, Mohamed; Tibby, Shane M.; Simmonds, Joy; Salih, Caner; Austin, Conal; Anderson, David; Krasemann, Thomas

doi:10.1017/s1047951117001019

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…The remaining full texts were requested via our library, but only 4 published in English were used. After consulting the full content of these 356 articles, only 17 fulfilled the inclusion criteria as set out above (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) (Table 1).…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Hypertension after coarctation repair—a systematic review

Panzer¹,

Bové²,

Vandekerckhove³

et al. 2022

Transl Pediatr

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Background: Coarctation of the Aorta (CoA) leads to increased morbidity and mortality later in life despite early surgical or percutaneous treatment. Many long-term complications are related to hypertension (HT) which is a common finding late after coarctation repair.Methods: A systematic Review was performed including articles published between February 2012 to December 2020. Systematic searches were conducted on PubMed and the Cochrane Controlled Trials Register to look for studies on HT after aortic CoA-repair. PRISMA guidelines were used.Results: In this systematic review on HT after CoA Repair the mean prevalence of HT was 47.3% (20-70%). A progressive character was of the HT was found, furthermore if only studies are included with 24 h blood pressure (BP) recording in addition to standard BP measurements, the incidence of HT rose to 57.8%. Discussion: Most clinical studies look at complications, mortality rate and residual pressure gradient rather than correlating hemodynamic indices with long-term outcome. Although HT is commonly based in measurement of peripheral BP, it has been shown that peripheral BP in CoA patients has a poor correlation with central aortic pressure. Central aortic hemodynamics are significantly altered in patients with repaired CoA, which can now adequately be investigated non-invasively. At the present time there are no studies linking long-term outcome with abnormal central hemodynamics.

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Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Hypertension after coarctation repair—a systematic review

Panzer¹,

Bové²,

Vandekerckhove³

et al. 2022

Transl Pediatr

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“…In our study patients with arterial hypertension were older and operated on at older age than normotensive subjects. The observations from other studies [22] reveal that younger age at operation is related to lower arterial pressure at follow-up; it is the best if treatment is applied before 9-10 years old. We did not observe the influence of type of surgery on development of arterial hypertension.…”

Section: Discussionmentioning

confidence: 88%

Long-term observation of adults after successful repair of aortic coarctation

Róg¹,

Okólska²,

Weryński³

et al. 2019

pwki

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Introduction: Despite successful repair of aortic coarctation, cardiovascular complications occur. Aim: To analyse type and frequency of late complications and their impact on exercise capacity in adults after aortic coarctation repair. Material and methods: Fifty-eight adults after aortic coarctation repair, 36 male, median age 27.46 ±10.57, were compared to 30 healthy volunteers. Physical examination, transthoracic echocardiography, carotid intima-media thickness measurement, cardiopulmonary exercise test and 24-hour ambulatory blood pressure monitoring were performed. Results: The main complications were: arterial hypertension 48.3%, myocardial hypertrophy in echocardiography 29.34%, recoarctation 25.86%, aortic dilation 13.79% and coronary artery disease 6.89%. Exercise tolerance was reduced in the cardiopulmonary exercise test. The VO 2 /kg peak was lower, 29.01 ±8.79 vs. 49.16 ±7.38 ml/kg/min, p < 0.001, VE/VCO 2 peak higher 28.18 ±4.69 vs. 26.78 ±3.13, p = 0.017. The peak heart rate was reduced, 157.28 ±22.22 vs. 177.93 ±23.08 bpm, p < 0.001, peak systolic blood pressure was higher, 174.79 ±17.62 vs. 153.33 ±4.79 mm Hg, p < 0.001. Systolic blood pressure in 24-hour ambulatory monitoring correlated with left ventricle mass index, r = 0.29, p = 0.025, wall thickness, r = 0.31, p = 0.039. Age at operation was related to left ventricle wall thickness, r = 0.27, p = 0.041, and carotid intima-media thickness, r = 0.26, p = 0.046. There was no association of any cardio-pulmonary parameters with time from surgery, type of operation or echocardiography results. Conclusions: Adults after aortic coarctation repair suffer from arterial hypertension, recurrent aortic stenosis, aortic aneurysms, and coronary artery disease. Reduced exercise capacity in cardio-pulmonary exercise test is related to hypertensive reaction and chronotropic incompetence.

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“…As reported elsewhere, currently CoAo is repaired at a very early age; in our series, the median age was 28 days, and about 80% were less than 12 months. Lillitos et al demonstrated that risk of medical treatment for hypertension was lowest when the primary repair was carried out during the neonatal period, with a 10‐fold increased risk if operated as a child. Thus, we speculate that the risk of late hypertension requiring treatment may be minimized by early repair of CoAo.…”

Section: Resultsmentioning

confidence: 99%

Surgical repair of aortic coarctation in pediatric age: A single center two decades experience

et al. 2019

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Background To evaluate early and long‐term results of surgical treatment of aortic coarctation (CoAo) in infants and children. Methods A retrospective clinical review of patients less than 18 years with CoAo, undergoing surgery between 1995 and 2015. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by bivariate, Cox's, and logistic regression analysis. Results Three hundred forty‐one consecutive patients (male/female: 192/149; the median age at surgery of 25 days; interquartile range [IQR], 10‐143 days) were included; 187 patients were less than 1 month (54.9%); 276 underwent extended end‐to‐end anastomosis (EEEA) (80.9%). Hypoplastic aortic arch (HAA) occurred in 34.6% and bicuspid aortic valve in 21.1%. The isolated type was present in 249 (73.0%). Significant postoperative complications occurred in 5.6%. Thirty‐day mortality was 1.4%. At a median follow‐up of 10.2 years (IQR, 6‐15 years; FU completeness, 91.2%), there were eight late deaths (2.6%), most in the complex type. Among 298 survivors, 284 (95.3%) were in NYHA class I; 10 (3.0%) were on antihypertensive treatment. Reinterventions on aortic arch occurred only in 4.5%, being HAA a significant risk factor for reoperation ( P = 0.00173). Freedom from mortality and reintervention on aorta at 21 years were 93.5% and 93.6%, respectively. Conclusions Surgical repair of CoAo by EEEA without CPBP is a safe and low‐risk procedure, concerning either early or late outcomes, despite the presence of HAA and neonatal age can influence recoarctation. Most patients are clinically well in the long‐term, and only a few require antihypertensive therapy.

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Is the medical treatment for arterial hypertension after primary aortic coarctation repair related to age at surgery? A retrospective cohort study

Cited by 7 publications

References 20 publications

Hypertension after coarctation repair—a systematic review

Hypertension after coarctation repair—a systematic review

Long-term observation of adults after successful repair of aortic coarctation

Surgical repair of aortic coarctation in pediatric age: A single center two decades experience

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