Recurrent Coarctation After Neonatal Univentricular and Biventricular Norwood-Type Arch Reconstruction

Abstract

Recurrent coarctation is common after NTAR. Small patient size and shunt type were found to be independent risk factors for recurrent coarctation in the 2V and SV populations, respectively, and discharge aortic arch gradient was a significant risk factor in both populations.

Acute and mid‐term outcomes of stent implantation for recurrent coarctation of the aorta between the Norwood operation and fontan completion: A multi‐center Pediatric Interventional Cardiology Early Career Society Investigation

“…Factors associated with higher rates of RC after BA included smaller patients and older age at the time of Norwood procedure [16]. In our study, 88% of patients who ultimately underwent SI for RC had previously undergone BA, which is consistent with estimates from prior studies that 15-20% of patients would be nonresponders to BA [7,16]. This also suggested BA being the first line treat- The most notable SAE in our cohort was hemodynamic instability, which was seen in 21% of patients.…”

“…Although typically attempted first, BA to treat RC is not uniformly acutely successful and often does not provide durable gradient relief. Studies have suggested a high success rate of BA but variable freedom of re-intervention [2,7,16]. Factors found to contribute to successful BA were larger balloon size, lower initial peak-to-peak gradient and larger diameter of descending aorta in one study [7].…”

“…Studies have suggested a high success rate of BA but variable freedom of re-intervention [2,7,16]. Factors found to contribute to successful BA were larger balloon size, lower initial peak-to-peak gradient and larger diameter of descending aorta in one study [7]. Factors associated with higher rates of RC after BA included smaller patients and older age at the time of Norwood procedure [16].…”

“…Transcatheter treatment of RC in SV patients using balloon angioplasty (BA) has been well described [2,7]. While BA is generally considered the first-line treatment for SV patients with RC, BA may result in inadequate acute relief of aortic obstruction, nondurable relief of obstruction (e.g., early recurrence), or both [8][9][10][11].…”

Intervention for arch obstruction after the Norwood procedure: Prevalence, associated factors, and practice variability

“…The reported prevalence of arch reintervention after the Norwood procedure ranges from 0% to 46% depending on institution and subsets of surgical technique. [2][3][4][5][6][7][8][9][10][11][12][13] An analysis of the Single Ventricle Reconstruction (SVR) trial data set has identified higher Norwood procedure discharge arch gradient and presence of a right ventricle to pulmonary artery conduit as risk factors for arch reintervention after the Norwood procedure. 10 Conditional survival analyses have shown that survival in patients after arch reintervention is equivalent to survival in those who do not undergo reintervention.…”