Long-Term Survival of Patients With Coarctation Repaired During Infancy (from the Pediatric Cardiac Care Consortium)

Oster, Matthew E.; Kiener, Alexander; Aylward, Brandon S.; Cory, Melinda; Hunting, John; Kochilas, Lazaros

doi:10.1016/j.amjcard.2019.05.047

Cited by 16 publications

(12 citation statements)

References 32 publications

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“…Predictors of mortality included weight less than 2.5 kg at repair, genetic syndrome, or repair prior to 1990. Although patients generally have excellent survival, there is a small ongoing attrition risk [24]. Although the data of this more recent treatment cohort are promising, further follow-up data are required as the attrition risk increase in the Brompton study was only observed after the third decade of life.…”

Section: Survival and Reinterventionmentioning

confidence: 95%

Challenges in diagnosis and management of coarctation of the aorta

Chetan

Mertens

2021

Current Opinion in Cardiology

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Purpose of reviewCoarctation of the aorta remains a controversial topic with uncertainties in long-term outcomes. Recent findingsRecent advances in fetal imaging including echocardiography and MRI offer novel opportunities for better detection and prediction of the need for neonatal intervention. New imaging techniques are providing novel insights about the impact of arch geometry and size on flow dynamics and pressure gradients. The importance of arch size rather than shape for optimal hemodynamics has been identified. Long-term outcome data suggest a significant increase in mortality risk in coarctation patients beyond the third decade when compared with the general population. Hypertension is highly prevalent not only in adult patients following repair of coarctation but also in normotensive patients presenting with LV diastolic dysfunction and adverse remodelling, indicating that abnormal vascular properties are important. Patients with coarctation undergoing neonatal repair are at risk for adverse neurodevelopmental outcomes and patients could benefit from timely neurocognitive evaluation and intervention.

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Section: Survival and Reinterventionmentioning

confidence: 95%

Challenges in diagnosis and management of coarctation of the aorta

Chetan

Mertens

2021

Current Opinion in Cardiology

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“…17 Doctors treat patients for a reason, and children who receive certain treatments may be fundamentally different from children who receive other treatments or none at all. To overcome confounding by indication, disease severity, and other factors in observational research, various designs may help reduce bias, including active-comparator designs, 15 Linkage between complementary data sources (eg, administrative claims with dispensing data and EHR data with metrics related to disease severity or growth) 18 Following individuals as their own controls over time to see whether the timing of treatment corresponds to the timing of outcomes, inherently controlling for time-invariant confounders (self-controlled study design) 19 Comparison of siblings to determine whether differences in treatments correspond to differences in outcomes, controlling for shared genetic and environment factors (sibling-controlled design) 20 Use of proxies of treatment selection, otherwise unrelated to the outcome (eg, variable prescribing practices independent of disease severity), for unbiased estimates of treatment effects (instrumental variable design) 21 RCT using broad inclusion criteria (eg, all children with persistent asthma in a health care system) and RWD collection (eg, EHR data) to produce RWE on treatment effectiveness or safety (pragmatic clinical trials) 22 Understanding the effects of dose on pediatric outcomes Use of linkable regional or national databases to study pediatric mortality as a study endpoint 26 Limited statistical power or selection bias in study of long-term pediatric outcomes because of loss to follow-up (eg, change in health plans, loss of insurance)…”

Section: Challengesmentioning

confidence: 99%

Real-World Evidence for Assessing Treatment Effectiveness and Safety in Pediatric Populations

Horton

Blum

Burcu

2021

The Journal of Pediatrics

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This article is endorsed by the International Society for Pharmacoepidemiology (ISPE). D.H. is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (K23AR070286 and R01AR074436) and received grant funding from Danisco USA Inc. M.Bu. is a fulltime employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and holds stock in Merck & Co., Inc., Kenilworth, NJ, USA.M.Bl. declares no conflicts of interest. This article reflects the views and opinions of the authors and should not be construed to represent the views and opinions of the US government, the US Food and Drug Administration, the National Institutes of Health, or any other public or private entity, who had no role in the writing of the report or the decision to submit the paper for publication.

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“…Traditionally, treatment of aortic arch pathology was a domain of cardiac surgery. [1][2][3][4][5][6] The advent of transcatheter procedures, along with improvement in equipment, has opened a new field enabling therapy in patients with native or previously repaired coarctation. [7][8][9][10] Percutaneous techniques, such as, balloon dilation and stenting, allow clinicians to safely decrease or abolish most gradients along the aorta, albeit with limitations.…”

Section: Introductionmentioning

confidence: 99%

“…Coarctation of the aorta includes a wide array of anatomical variations that may cause important long‐term morbidity and mortality. Traditionally, treatment of aortic arch pathology was a domain of cardiac surgery 1‐6 . The advent of transcatheter procedures, along with improvement in equipment, has opened a new field enabling therapy in patients with native or previously repaired coarctation 7‐10 .…”

Section: Introductionmentioning

confidence: 99%

Acute and medium term results of balloon expandable stent placement in the transverse arch—a multicenter pediatric interventional cardiology early career society study

Shahanavaz

Aldoss

Carr

et al. 2020

Cathet Cardio Intervent

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Objectives and Background: Coarctation of the aorta represents 5-8% of all congenital heart disease. Although balloon expandable stents provide an established treatment option for native or recurrent coarctation, outcomes from transverse arch (TAO) stenting, including resolution of hypertension have not been well studied. This study aims to evaluate immediate and midterm results of TAO stenting in a multicenter retrospective cohort. Methods: TAO stenting was defined as stent placement traversing any head and neck vessel, with the primary intention of treating narrowing in the transverse aorta. Procedural details, complications and medications were assessed immediately post procedure, at 6 month follow-up and at most recent follow-up. Results: Fifty-seven subjects, 12 (21%) native, and 45 (79%) surgically repaired aortic arches, from seven centers were included. Median age was 14 years (4 days-42 years), median weight 54 kg (1.1-141 kg). After intervention, the median directly measured arch gradient decreased from 20 mmHg (0-57 mmHg) to 0 mmHg (0-23 mmHg) (p < .001). The narrowest arch diameter increased from 9 mm (1.4-16 mm) to 14 mm (2.9-25 mm) (p < .001), with a median increase of 4.9 mm (1.1-10.1 mm). One or more arch branches were covered by the stent in 55 patients (96%). There were no serious adverse events. Two patients warranted stent repositioning following migration during deployment. There were no late complications. There were 8 reinterventions, 7 planned, and 1 unplanned (6 catheterizations, 2 surgeries). Antihypertensive management was continued in 19 (40%) at a median follow-up of 3.2 years (0.4-7.3 years). Conclusions: TAO stenting can be useful in selected patients for resolution of stenosis with minimal complications. This subset of patients are likely to continue on antihypertensive medications despite resolution of stenosis.

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Long-Term Survival of Patients With Coarctation Repaired During Infancy (from the Pediatric Cardiac Care Consortium)

Cited by 16 publications

References 32 publications

Challenges in diagnosis and management of coarctation of the aorta

Challenges in diagnosis and management of coarctation of the aorta

Real-World Evidence for Assessing Treatment Effectiveness and Safety in Pediatric Populations

Acute and medium term results of balloon expandable stent placement in the transverse arch—a multicenter pediatric interventional cardiology early career society study

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