Neurological complications in aortic coarctation: Results of a Nationwide analysis based on 11,907 patients

Trenk, Lukas; Lammers, Astrid E.; Radke, Robert; Baumgartner, Helmut; Wort, Stephen J.; Diller, Gerhard‐Paul; Kempny, Aleksander

doi:10.1016/j.ijcard.2020.08.041

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…The interpretation of this phenomenon is rather contradictory. Although ischemic strokes are extremely rare after aortic coarctation repair in children, other authors claim that they occur more often in older patients with significant arterial hypertension or in the presence of cerebral vascular anomalies (Willis circle anomalies, hypoplastic vertebral arteries) [18,19]. Patients with LBW and prematurity have lower peripheral vascular resistance and are more prone to hypotension due to immaturity of peripheral vasoregulation [20], and, in our opinion, such patients better tolerate manipulations with the aortic arch during the surgery.…”

Section: Discussionmentioning

confidence: 99%

Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis

Krylova,

Svobodov,

Tumanyan

et al. 2023

Life

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Introduction: Surgical treatment of aortic coarctation in low-birth-weight (LBW) neonates is associated with risks of higher hospital mortality rates and recoarctation development in the long-term. The goal of our study was to compare the results of surgical treatment of aortic coarctation in LBW neonates and normal-weight patients, to identify predictors of recoarctation in the long-term among LBW patients. Materials and methods: A retrospective study was performed to analyse the patients who had undergone resection of isolated aortic coarctation between 2005 and 2022. Overall analysis included 521 patients under the age of 30 days, 89 LBW patients and 432 patients with normal body weight. Propensity score matching (PSM) was performed at a ratio of 1:1 for the statistical adjustment of original patients’ data in both groups. Results: All patients underwent standard resection of aortic coarctation with extended end-to-end anastomosis. Hospital mortality among LBW patients was 8% and in patients with normal weight the mortality amounted to 1% (p = 0.030). LBW patients were transferred to other hospitals more often than normal-weight patients who were more often discharged (p < 0.001). In the long-term, period mortality was not statistically significantly different (p = 0.801). The freedom from reoperation in the group of normal-weight children was 87%, whereas in the LBW patients the rate was 63% (log rank test, p = 0.104). In the multivariate regression model, the most significant risk factors for reoperation were as follows: preoperative inotropes administration (OR (95% CI) 4.369 (1.316–14.51)) and pressure gradient across aortic arch before discharge (OR (95% CI) 1.081 (1.014–1.153)). Conclusions: Hospital mortality was higher among LBW patients (p = 0.030). There was a statistical trend of differences in reoperation rates: in the long-term among LBW patients, a higher reintervention probability remains. Moreover, the LBW group initially had more severe clinical condition in terms of cardiac failure and impaired renal function. Factors associated with the risk of recoarctation were preoperative inotropes infusion and pressure gradient across aortic before discharge.

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Section: Discussionmentioning

confidence: 99%

Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis

Krylova,

Svobodov,

Tumanyan

et al. 2023

Life

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“…21 This lack of cerebral vascular elasticity may make the brain more di cult to adapt to the hemodynamics stress caused by the waves, as indicated by the substantially higher EEG sharp wave number and worse background abnormalites in Aorta Group. 26,27 Attention has been increasingly paid to cerebral vascular changes, like intracranial aneurysm, 28 and brain injuries, like stroke, 29 from the early perioperative period into adulthood in patients with aortic arch abnormalities. 29,30 When the arterial pressure waves occurred, synchronized uctuations in ScO 2 were also observed in most of patients, re ecting a loss of cerebral autoregulation.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 Attention has been increasingly paid to cerebral vascular changes, like intracranial aneurysm, 28 and brain injuries, like stroke, 29 from the early perioperative period into adulthood in patients with aortic arch abnormalities. 29,30 When the arterial pressure waves occurred, synchronized uctuations in ScO 2 were also observed in most of patients, re ecting a loss of cerebral autoregulation. 7 The loss of cerebral autoregulation has been well documented in children undergoing CPB 8,31,32 and other critically ill patients like sepsis.…”

Section: Discussionmentioning

confidence: 99%

The novel and slowest arterial pressure waves: clinical implications in children with congenital heart disease following cardiovascular surgery

Ma,

Yu,

Liu

et al. 2023

Preprint

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Objective Certain rhythmic arterial pressure waves in humans and animals have been noticed over one century. We found the noval and slowest arterial pressure waves in children following surgerical repair for congenital heart disease (CHD), and examined their characteristics and clinical implications. Methods We enrooled 212 children with 22 types of CHD during and in the first postoperative 48 hours. We monitored hemodynamics, including blood pressure, heart rate, cardiac cycle efficiency (CCE), and dP/dTmax using pressure recording analytical method by MostCare, and cerebral (ScO2) and renal (SrO2) oxygen saturation using near-infrared spectroscopy every 6 seconds. EEG was continuously monitored. Transcranial Doppler was used to measure the mean blood flow velocity (Vm) of the middle cerebral artery at the 24th hours. Results We found the waves with a frequency of ~ 90 seconds immediately following surgical repair in 46 patients in 12 types of CHD (21.7%), being most prevalent in patients with aortic arch abnormalities (Aorta Group, n = 24, 42.3%) or with ventricular septal defect (VSD) (VSD Group, n = 12, 23.5%). In Aorta and VSD Groups, the occurrence of the waves was asscoated with lower blood pressures, dP/dTmax, CCE, ScO2 and SrO2, Vm and worse EEG background abnormalities and higher number of EEG sharp waves, and serum lactate (Ps < 0.0001-0.07). The waves were accompanied with fluctuations of ScO2 and SrO2 in 80.6% and 69.6% of patients respectively. Conclusions The waves observed in children with CHD following cardiovascular surgery are the slowest ever reported, occurring most frequently in patients with aortic arch abnormalities or VSD. The presence of the waves was associated with worse and fluctuated ScO2 and SrO2, worse systemic hemodynamics and EEG abnormalities.

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“…Subarachnoid haemorrhage and ischaemic stroke due to permanent hypertension develop in many patients, especially at a young age. 21,22 Spinal cord ischaemia is also an important problem, especially in adult patients. 23 In our study, seizures were the only major complication observed in the early and late post-operative periods.…”

Section: Discussionmentioning

confidence: 99%

Isolated coarctation repair through a left thoracotomy in children

et al. 2022

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Introduction: Isolated aortic coarctation performed through a left thoracotomy resection and end-to-end anastomosis results in low mortality and morbidity rates. Recoarctation and late hypertension are among the most important complications after such repairs. In this study, we reviewed the results of children who underwent left-side thoracotomy to correct an isolated aortic coarctation. Method: A consecutive sample of 90 patients who underwent resection and extended end-to-end anastomosis through a left-side thoracotomy in our centre between 2011 and 2021 was retrospectively analysed. The patients' preoperative characteristics, operative data, and post-operative early and long-term results were examined Results: All patients underwent resection and extended end-to-end anastomosis. A pulmonary artery band was applied simultaneously to three (3.3%) patients, and an aberrant right subclavian artery division was applied to one (1.1%) patient. The mean cross-clamp time was 29.13 ± 6.97 minutes. Two (2.2%) patients required reoperation in the early period. Mortality was observed in one (1.1%) patient in the early period. Eight (8.8%) patients developed recoarctation, of whom four (4.4%) underwent reoperation and four (4.4%) underwent balloon angioplasty. Twenty-two (26.8%) patients received follow-up antihypertensive treatment. The mean follow-up period was 41.3 ± 22.8 months. No mortality was observed in the late period. Conclusion: Isolated coarctation is successfully treated with left-side thoracotomy resection and an extended end-to-end anastomosis technique with low mortality, morbidity, and low long-term recoarctation rates. Long-term follow-up is required due to the risks of early and late post-operative recoarctation, which requires reintervention.

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Neurological complications in aortic coarctation: Results of a Nationwide analysis based on 11,907 patients

Cited by 8 publications

References 26 publications

Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis

Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis

The novel and slowest arterial pressure waves: clinical implications in children with congenital heart disease following cardiovascular surgery

Isolated coarctation repair through a left thoracotomy in children

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