Restenosis Rate and Reinterventions after Aortic Arch Repair in Infants

DOI: https://doi.org/10.30702/ujcvs/22.30(04)/TG056-5965
Keywords: recurrent obstruction, balloon angioplasty, surgical reconstruction, risk factors for mortality, hypoplasia

Abstract

The aim. This study aims to determine the reintervention rate in infantsundergoing aortic arch repair and to analyze risk factors and evaluate the results of reinterventions.

Materials and methods. This retrospective study examines 445 infants with aortic arch hypoplasia who under-went aortic arch reconstruction between 2011 and 2019. The study included only patients with two-ventricle physiology and subsequent two-ventricle repair. Techniques for primary repair included extended end-to-end anastomosis (n = 348), end-to-side anastomosis (n = 611), autologous pericardial patch repair (n = 16).

Results. The overall mortality in the entire study group was 3.3 %. Follow-up period ranged from 1 month to 9.4 years (mean 2.8 ± 2.5 years). Restenosis at the site of aortic arch repair was identiϐied in 47 (10.5 %) patients. Of these, 12 patients underwent surgical reconstruction of the aortic arch, 27 patients underwent balloon angioplasty, and in 8 patients both methods were used. Freedom from reintervention was 89.4 % at 1-year follow-up and 87.5 % at 4-year follow-up. The most determining factorsfor restenosis were related to hypoplastic proximal aortic arch and body weight less than 2.5 kg.

Conclusions. Surgical treatment of aortic arch hypoplasia in newborns and infants is effective and shows good immediate and long-term results. Anatomical correction of reobstruction at the level of the aortic arch is safe with both endovacular and surgical methods with low mortality and incidence of repeated interventions. Identified risk factors for mortality and recurrent aortic arch interventions help to improve the treatment of aortic arch hypoplasia in patients under 1 year of age.

References

  1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39(12):1890-900. https://doi.org/10.1016/s0735-1097(02)01886-7
  2. Mery CM, Khan MS, Guzmán-Pruneda FA, Verm R, Umakanthan R, Watrin CH, et al. Contemporary Results of Surgical Repair of Recurrent Aortic Arch Obstruction. Ann Thorac Surg. 2014;98(1):133-40; discussion 140-1. https://doi.org/10.1016/j.athoracsur.2014.01.065
  3. DiBardino DJ, Heinle JS, Kung GC, Leonard GT Jr, McKenzie ED, Su JT, et al. Anatomic reconstruction for recurrent aortic obstruction in infants and children. Ann Thorac Surg. 2004;78(3):926-32; discussion 926-32. https://doi.org/10.1016/j.athoracsur.2004.02.126
  4. Walhout RJ, Lekkerkerker JC, Oron GH, Hitchcock FJ, MeijboomEJ, Bennink GB. Comparison of polytetraϐluoroethylene patch aortoplasty and end-to-end anastomosis for coarctation of the aorta. J Thorac Cardiovasc Surg. 2003;126(2):521-8. https://doi.org/10.1016/s0022-5223(03)00030-8
  5. McElhinney DB, Yang SG, Hogarty AN, Rychik J, Gleason MM, Zachary CH, et al. Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: is low weight a risk factor? J Thorac Cardio-vasc Surg. 2001;122(5):883-90. https://doi.org/10.1067/mtc.2001.116316
  6. Thomson JD, Mulpur A, Guerrero R, Nagy Z, Gibbs JL, Watterson KG. Outcome after extended arch repair for aortic coarctation. Heart. 2006;92(1):90-4. https://doi.org/10.1136/hrt.2004.058685
  7. Toro-Salazar OH, Steinberger J, Thomas W, Rocchini AP, Carpenter B, Moller JH. Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol. 2002;89(5):541-7. https://doi.org/10.1016/s0002-9149(01)02293-7
  8. Zoghbi J, Serraf A, Mohammadi S, Belli E, Lacour Gayet F, Aupecle B, et al. Is surgical intervention still indicated in recurrentaortic arch obstruction? J Thorac Cardiovasc Surg. 2004;127(1):203-12. https://doi.org/10.1016/s0022-5223(03)01290-x
  9. Alkashkari W, Albugami S, Althobaiti M, Alfouti M, Alrahimi J, Kinsara A, et al. Transcatheter Intervention for Late Com-plications after Aortic Coarctation Surgical Repair. J Clin Trials. 2020;10(2):402. https://doi.org/10.35248/2167-0870.20.10.402
  10. Ralph-Edwards AC, Williams WG, Coles JC, Rebeyka IM, Trusler GA, Freedom RM. Reoperation for Recurrent Aortic Coarctation. Ann Thorac Surg. 1995;60(5):1303-7. https://doi.org/10.1016/0003-4975(95)00619-V
  11. Dias MQ, Barros A, Leite-Moreira A, Miranda JO. Risk Factors for Recoarctation and Mortality in Infants Submitted to Aortic Coarctation Repair: A Systematic Review. Pediatr Cardiol. 2020;41(3):561-75. https://doi.org/10.1007/s00246-020-02319-w
  12. Lehnert A, Villemain O, Gaudin R, Meot M, Raisky O, Bonnet D. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact Cardiovasc Thorac Surg.2019;29(3):469-75. https://doi.org/10.1093/icvts/ivz117
  13. Burch PT, Cowley CG, Holubkov R, Null D, Lambert LM, Kouretas PC, et al. Coarctation repair in neonates and young infants: is small size or low weight still a risk factor?J Thorac Cardiovasc Surg. 2009;138(3):547-52. https://doi.org/10.1016/j.jtcvs.2009.04.046
  14. Bacha EA, Almodovar M, Wessel DL, Zurakowski D, Mayer JE Jr, Jonas RA, et al. Surgery for coarctation of the aorta in infants weighing less than 2 kg. Ann Thorac Surg. 2001;71(4):1260-4. https://doi.org/10.1016/s0003-4975(00)02664-3
  15. Sudarshan CD, Cochrane AD, Jun ZH, Soto R, Brizard CP. Repair of coarctation of the aorta in infants weighing less than 2 kilograms. Ann Thorac Surg. 2006;82(1):158-63. https://doi.org/10.1016/j.athoracsur.2006.03.007
  16. Jiang Q, Hu R, Dong W, Guo Y, Zhang W, Hu J, et al. Outcomes of Arch Reintervention for Recurrent Coarctation in Young Children. Thorac Cardiovasc Surg. 2022;70(1):26-32. https://doi.org/10.1055/s-0041-1731825
  17. Adamson G, Karamlou T, Moore P, Natal-Hernandez L, Tabbutt S, Peyvandi S. Coarctation Index Predicts Recurrent Aortic Arch Obstruction Following Surgical Repair of Coarctation of the Aorta in Infants. Pediatr Cardiol. 2017;38(6):1241-6. https://doi.org/10.1007/s00246-017-1651-4
  18. Ramachandran P, Khoury PR, Beekman RH, Michelfelder EC, Manning PB, Tweddell JS, et al. Preoperative Aortic Arch Size and Late Outcome After Coarctation Repair by Lateral Thoracotomy. Ann Thorac Surg. 2018;106(2):575-80. https://doi.org/10.1016/j.athoracsur.2018.03.084
  19. Truong DT, Tani LY, Minich LL, Burch PT, Bardsley TR, MenonSC. Factors Associated with Recoarctation After Surgical Repair of Coarctation of the Aorta by way of Thoracotomy in Young Infants. Pediatr Cardiol. 2014;35(1):164-70. https://doi.org/10.1007/s00246-013-0757-6
  20. Wu JL, Leung MP, Karlberg J, Chiu C, Lee J, Mok CK. Surgical repair of coarctation of the aorta in neonates: factors affecting early mortality and re-coarctation. Cardiovasc Surg. 1995;3(6):573-8. https://doi.org/10.1016/0967-2109(96)82849-3
  21. Dodge-Khatami A, Backer CL, Mavroudis C. Risk Factors for Recoarctation and Results of Reoperation: A 40-Year Review. J Card Surg. 2000;15(6):369-77. https://doi.org/10.1111/j.1540-8191.2000.tb01295.x
  22. Jonas RA. Coarctation: Do We Need to Resect Ductal Tissue? Ann Thorac Surg. 1991;52(3):604-7. https://doi.org/10.1016/0003-4975(91)90957-r
  23. Kim ER, Kim WH, Nam J, Choi K, Jang WS, Kwak JG. Mid-Term Outcomes of Repair of Coarctation of Aorta With Hypoplastic Arch: Extended End-to-side Anastomosis Technique. Semin Thorac Cardiovasc Surg. 2017:S1043-0679(17)30289-7. https://doi.org/10.1053/j.semtcvs.2017.10.002
  24. Hager A, Schreiber C, Nutzl S, Hess J. Mortality and Restenosis Rate of Surgical Coarctation Repair in Infancy: A Study of 191 Patients. Cardiology. 2009;112(1):36-41. https://doi.org/10.1159/000137697
  25. McCrindle BW, Jones TK, Morrow WR, Hagler DJ, Lloyd TR, Nouri S, et al. Acute Results of Balloon Angioplasty of Native Coarctation Versus Recurrent Aortic Obstruction Are Equivalent. J Am Coll Cardiol. 1996;28(7):1810-7. https://doi.org/10.1016/s0735-1097(96)00379-8
  26. Brown JW, Ruzmetov M, Hoyer MH, Rodefeld MD, Turrentine MW. Recurrent Coarctation: Is Surgical Repair of Recurrent Coarctation of the Aorta Safe and Effective? Ann Thorac Surg. 2009;88(6):1923-30; discussion 1930-1. https://doi.org/10.1016/j.athoracsur.2009.07.024
Published
2022-12-26
How to Cite
Truba, I. P., Golovenko, O. S., & Dziuryi, I. V. (2022). Restenosis Rate and Reinterventions after Aortic Arch Repair in Infants. Ukrainian Journal of Cardiovascular Surgery, 30(4), 59-65. https://doi.org/10.30702/ujcvs/22.30(04)/TG056-5965
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 30 No 4 2022
Section
CONGENITAL HEART DEFECTS