Procedural risk factors, incidence and timing of reintervention after treatment for native coarctation of the aorta in children: a population-based study†

Ylinen, Mari K; Tyni, Ville E; Pihkala, Jaana; Salminen, Jukka; Sairanen, Heikki; Sarkola, Taisto

doi:10.1093/ejcts/ezy252

Cited by 13 publications

(8 citation statements)

References 23 publications

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“…Tulzer et al reported that EEEA could be performed with low perioperative mortality and morbidity, with freedom from reintervention of 90.12% at 10 years. In our experience, an aortic arch reintervention occurred in 4.4% at a very long‐term follow‐up, which compares better to most recent reports . Despite HAA was found to be a significant risk factor for recoarctation, as elsewhere reported, in our experience, EEEA for patients with HAA was still effective, since its freedom from reintervention on aorta was significantly higher than EEA (Figure B).…”

Section: Resultssupporting

confidence: 81%

“…B, When analyzing survival among the three classes of age, there was a significant difference between patients operated less than 1 month and the remaining (P = 0.0095); in particular, when comparing neonates with infants and children, P = 0.0172 and 0.0131, respectively reports. 13,[16][17][18] Despite HAA was found to be a significant risk factor for recoarctation, as elsewhere reported, 14 in our experience, EEEA for patients with HAA was still effective, since its freedom from reintervention on aorta was significantly higher than EEA ( Figure 3B).…”

Section: Commentsupporting

confidence: 79%

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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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Section: Resultssupporting

confidence: 81%

Section: Commentsupporting

confidence: 79%

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

et al. 2019

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“…Surgical reinterventions were related to lower body weight and smaller aortic dimensions at the time of surgery. In the percutaneous group, higher residual gradients or planned repeat procedures were associated with reintervention [21]. These data suggest a benefit for surgery in smaller patients.…”

Section: Survival and Reinterventionmentioning

confidence: 72%

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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“…[9][10][11]21,24,25 İlk bir yaşta balon anjiyoplasti sonrası rekoarktasyon sıklığı %40, 1 yaş üstü çocuklarda %10-30 olarak bulunmuştur. 12,16,20,22,26,27 Rekoarktasyon oranlarımızın diğer çalışmalara göre daha yüksek olması, yaş gruplarının daha küçük çocuklardan meydana gelmesi ile açıklanabilir. Süt çocukluğu grubunda (4-12 ay) hastaların büyük çoğunluğunu (%85) 4-6 aylık çocuklar oluşturuyorken, yine aynı şekilde 1 yaş üzeri grupta, hastaların yarısını 13-36 aylık çocuklar oluşturmuştur.…”

Section: Discussionunclassified

Determination of Factors Affecting the Results of Balloon Angioplasty in Coarctation of Aorta

Sarısoy¹,

Ayabakan²,

Tokel³

2019

Turkiye Klinikleri J Cardiovasc Sci

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Aort koarktasyonunda balon anjiyoplastinin başarısını, sonuçlarını, rekoarktasyon sıklığını ve bunu etkileyen faktörleri saptamaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Nisan 2007-Mayıs 2012 tarihleri arasında koarktasyon tanısıyla balon anjiyoplasti yapılan 53 hastanın verileri retrospektif olarak değerlendirildi. B Bu ul lg gu ul la ar r: : Ortalama yaş 14,7±35,5 (0,1-198) ay, ağırlık 7,8±8,9 kg; 23 (%43)'ü kız, 30 (%57)'u erkek hasta idi. Yaş grupları balon öncesi ve sonrası arkus ve istmus z değerleri açısından karşılaştırıldı. Balon öncesi ve sonrası, 0-3 ay (grup 1) ile 12 ay üzeri grupta arkus Z-skorları ve istmus Z-skorları, ayrıca 4-12 ay (grup 2) ile 12 ay üzeri (grup 3) grupta yine arkus aorta ve istmus Z-skorları açısından fark anlamlı bulundu. Balon öncesi sistolik basınç gradientinin ortalama 35,8±18,2 mmHg'dan, 13,8±10 mmHg'a gerilediği, koarktasyon çapının 3,3±1,9 mm'den 4,9±2,6 mm'ye arttığı görüldü. Anjiyoplasti öncesinde çıkan aorta, istmus, distal aortik arkus ve abdominal aorta çaplarının, anjiyoplasti sonrasında anlamlı olarak arttığı belirlendi. İşlem başarısı tüm hastalarda %81; 0-3 ayda %79, 4-12 ayda %77, 12 ay üzerinde ise %92 olarak bulundu. Yaş ile rekoarktasyon arasında anlamlı ilişki belirlendi. Balon öncesi istmus çapı, çıkan aorta çapının %50'si ve altında olanlarda rekoarktasyon sıklığının anlamlı düzeyde yüksek olduğu belirlendi. Komplikasyon oranı %19 olarak saptandı. S So on nu uç ç: : Balon anjiyoplasti, koarktasyon tedavisinde cerrahiye alternatif ve güvenli bir tedavi yöntemidir. Balon öncesi ve sonrasında distal transvers arkus çapı ve Z-skoru, istmus çapı ve Z-skoru, koarktasyon bölgesinin çapı rekoarktasyon ile ilişkili önemli ölçümlerdir. Yaş ve ciddi istmus hipoplazisi, rekoarktasyon için anlamlı risk faktörleridir.

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Procedural risk factors, incidence and timing of reintervention after treatment for native coarctation of the aorta in children: a population-based study†

Abstract: Reinterventions after surgery in neonates were relatively common. In older children, percutaneous treatment carried a higher risk of reinterventions, which were mainly related to residual coarctation after primary treatment.

Cited by 13 publications

References 23 publications

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

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

Challenges in diagnosis and management of coarctation of the aorta

Determination of Factors Affecting the Results of Balloon Angioplasty in Coarctation of Aorta

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