Outcomes of arch reintervention for post-repair recoarctation: A retrospectivel analysis in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Qi ¹ , HU Renjie ¹ , DONG Wei ¹ , GUO Ying ² , ZHANG Wen ¹ , HU Jie ¹ , ZHU Yifan ¹ ,  ZHANG Haibo ¹

1. Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P. R. China;
2. Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P. R. China;

Corresponding author：

ZHANG Haibo, Email: zhanghaibosh@126.com

Keywords：

Aortic coarctation; recoarctation; congenital heart disease; balloon angioplasty; reoperation; restenosis

DOI：

10.7507/1007-4848.202011083

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Objective To discuss outcomes of arch reintervention for post-repair recoarctation in children.Methods From 2009 to 2019, 48 patients underwent reintervention for post-repair recoarctation in Shanghai Children’s Medical Center. Of the 48 patients, 22 patients had surgical repair, 25 patients had balloon angioplasty (BA), and 1 patient had a stent implantation. The clinical data were analyzed, and the difference in time-to-event distribution between the surgical group and the BA group was determined by a log-rank test.Results The median age at reintervention was 15.0 months (range, 3.0 months-15.1 years). The median weight at reintervention was 9.8 kg (range, 3.0-58.0 kg). The time to reintervention after initial repair was 12.5 months (range, 2.0 months-7.8 years). One patient (2.1%) died in hospital and 1 patient (2.1%) experienced arrhythmia after surgical repair. One late mortality (2.1%) occurred after surgical reintervention. One patient (2.1%) experienced aortic dissection after BA. No patient died after BA. Freedom from residual coarctation or new recurrences was 66.7%, 61.3%, and 56.9%, respectively, at 1, 2, and 5 years after reintervention. Freedom from residual coarctation or new recurrences was 90.0%, 81.8%, and 70.1%, respectively, at 1, 2, and 5 years after surgical repair. Freedom from residual coarctation or new recurrences was 52.0%, 48.0%, and 48.0%, respectively, at 1, 2, and 5 years after BA. Compared with BA, surgery-based reintervention had a lower incidence of residual coarctation or recurrences (χ²=4.400, P=0.036).Conclusion Reintervention for recoarctation has favorable early outcomes. Compared with balloon angioplasty, surgical repair has a more lasting effect in relieving the recoarctation.

Citation： JIANG Qi, HU Renjie, DONG Wei, GUO Ying, ZHANG Wen, HU Jie, ZHU Yifan, ZHANG Haibo. Outcomes of arch reintervention for post-repair recoarctation: A retrospectivel analysis in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1472-1477. doi: 10.7507/1007-4848.202011083 Copy

1.	张海波, 李守军, 代表国家心血管病专家委员会先天性心脏病专业委员会. 先天性心脏病外科治疗中国专家共识(十一): 主动脉缩窄与主动脉弓中断. 中国胸心血管外科临床杂志, 2020, 27(11): 1255-1261.
2.	Ungerleider RM, Pasquali SK, Welke KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg, 2013, 145(1): 150-157.
3.	Turek JW, Conway BD, Cavanaugh NB, et al. Bovine arch anatomy influences recoarctation rates in the era of the extended end-to-end anastomosis. J Thorac Cardiovasc Surg, 2018, 155(3): 1178-1183.
4.	Dias MQ, Barros A, Leite-Moreira A, et al. Risk factors for recoarctation and mortality in infants submitted to aortic coarctation repair: A systematic review. Pediatr Cardiol, 2020, 41(3): 561-575.
5.	Tulzer A, Mair R, Kreuzer M, et al. Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach. J Thorac Cardiovasc Surg, 2016, 152(6): 1506-1513.
6.	Lee MGY, Allen SL, Koleff J, et al. Impact of arch reobstruction and early hypertension on late hypertension after coarctation repair. Eur J Cardiothorac Surg, 2018, 53(3): 531-537.
7.	Luijendijk P, Bouma BJ, Groenink M, et al. Surgical versus percutaneous treatment of aortic coarctation: New standards in an era of transcatheter repair. Expert Rev Cardiovasc Ther, 2012, 10(12): 1517-1531.
8.	Wong JSY, Lee MGY, Brink J, et al. Are more extensive procedures warranted at the time of aortic arch reoperation? Eur J Cardiothorac Surg, 2017, 52(6): 1132-1138.
9.	Feltes TF, Bacha E, Beekman RH 3rd, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: A scientific statement from the American Heart Association. Circulation, 2011, 123(22): 2607-2652.
10.	Mery CM, Guzmán-Pruneda FA, Carberry KE, et al. Aortic arch advancement for aortic coarctation and hypoplastic aortic arch in neonates and infants. Ann Thorac Surg, 2014, 98(2): 625-633.
11.	Chiu HH, Chiu SN, Hu FC, et al. Late cardiovascular complications after surgical or balloon angioplasty of coarctation of aorta in an Asian cohort. Am J Cardiol, 2009, 104(8): 1139-1144.
12.	Gray WH, Wells WJ, Starnes VA, et al. Arch augmentation via median sternotomy for coarctation of aorta with proximal arch hypoplasia. Ann Thorac Surg, 2018, 106(4): 1214-1219.
13.	Brown JW, Ruzmetov M, Hoyer MH, et al. Recurrent coarctation: Is surgical repair of recurrent coarctation of the aorta safe and effective? Ann Thorac Surg, 2009, 88(6): 1923-1930.
14.	Christopher AB, Apfel A, Sun T, et al. Diastolic velocity half time is associated with aortic coarctation gradient at catheterization independent of echocardiographic and clinical blood pressure gradients. Congenit Heart Dis, 2018, 13(5): 713-720.
15.	Früh S, Knirsch W, Dodge-Khatami A, et al. Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood. Eur J Cardiothorac Surg, 2011, 39(6): 898-904.
16.	Brown ML, Burkhart HM, Connolly HM, et al. Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation, 2010, 122(11 Suppl): S81-S84.
17.	Reich O, Tax P, Bartáková H, et al. Long-term (up to 20 years) results of percutaneous balloon angioplasty of recurrent aortic coarctation without use of stents. Eur Heart J, 2008, 29(16): 2042-2048.
18.	Gendera K, Ewert P, Tanase D, et al. Balloon-expandable stents for recoarctation of the aorta in small children. Two centre experience. Int J Cardiol, 2018, 263: 34-39.
19.	Brzezinska-Rajszys G. Stents in treatment of aortic coarctation and recoarctation in small children. Int J Cardiol, 2018, 263: 40-41.
20.	Sakopoulos AG, Hahn TL, Turrentine M, et al. Recurrent aortic coarctation: Is surgical repair still the gold standard? J Thorac Cardiovasc Surg, 1998, 116(4): 560-565.
21.	Lefort B, Lachaud M, El Arid JM, et al. Immediate and midterm results of balloon angioplasty for recurrent aortic coarctation in children aged<1 year. Arch Cardiovasc Dis, 2018, 111(3): 172-179.

1. 张海波, 李守军, 代表国家心血管病专家委员会先天性心脏病专业委员会. 先天性心脏病外科治疗中国专家共识(十一): 主动脉缩窄与主动脉弓中断. 中国胸心血管外科临床杂志, 2020, 27(11): 1255-1261.
2. Ungerleider RM, Pasquali SK, Welke KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg, 2013, 145(1): 150-157.
3. Turek JW, Conway BD, Cavanaugh NB, et al. Bovine arch anatomy influences recoarctation rates in the era of the extended end-to-end anastomosis. J Thorac Cardiovasc Surg, 2018, 155(3): 1178-1183.
4. Dias MQ, Barros A, Leite-Moreira A, et al. Risk factors for recoarctation and mortality in infants submitted to aortic coarctation repair: A systematic review. Pediatr Cardiol, 2020, 41(3): 561-575.
5. Tulzer A, Mair R, Kreuzer M, et al. Outcome of aortic arch reconstruction in infants with coarctation: Importance of operative approach. J Thorac Cardiovasc Surg, 2016, 152(6): 1506-1513.
6. Lee MGY, Allen SL, Koleff J, et al. Impact of arch reobstruction and early hypertension on late hypertension after coarctation repair. Eur J Cardiothorac Surg, 2018, 53(3): 531-537.
7. Luijendijk P, Bouma BJ, Groenink M, et al. Surgical versus percutaneous treatment of aortic coarctation: New standards in an era of transcatheter repair. Expert Rev Cardiovasc Ther, 2012, 10(12): 1517-1531.
8. Wong JSY, Lee MGY, Brink J, et al. Are more extensive procedures warranted at the time of aortic arch reoperation? Eur J Cardiothorac Surg, 2017, 52(6): 1132-1138.
9. Feltes TF, Bacha E, Beekman RH 3rd, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: A scientific statement from the American Heart Association. Circulation, 2011, 123(22): 2607-2652.
10. Mery CM, Guzmán-Pruneda FA, Carberry KE, et al. Aortic arch advancement for aortic coarctation and hypoplastic aortic arch in neonates and infants. Ann Thorac Surg, 2014, 98(2): 625-633.
11. Chiu HH, Chiu SN, Hu FC, et al. Late cardiovascular complications after surgical or balloon angioplasty of coarctation of aorta in an Asian cohort. Am J Cardiol, 2009, 104(8): 1139-1144.
12. Gray WH, Wells WJ, Starnes VA, et al. Arch augmentation via median sternotomy for coarctation of aorta with proximal arch hypoplasia. Ann Thorac Surg, 2018, 106(4): 1214-1219.
13. Brown JW, Ruzmetov M, Hoyer MH, et al. Recurrent coarctation: Is surgical repair of recurrent coarctation of the aorta safe and effective? Ann Thorac Surg, 2009, 88(6): 1923-1930.
14. Christopher AB, Apfel A, Sun T, et al. Diastolic velocity half time is associated with aortic coarctation gradient at catheterization independent of echocardiographic and clinical blood pressure gradients. Congenit Heart Dis, 2018, 13(5): 713-720.
15. Früh S, Knirsch W, Dodge-Khatami A, et al. Comparison of surgical and interventional therapy of native and recurrent aortic coarctation regarding different age groups during childhood. Eur J Cardiothorac Surg, 2011, 39(6): 898-904.
16. Brown ML, Burkhart HM, Connolly HM, et al. Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation, 2010, 122(11 Suppl): S81-S84.
17. Reich O, Tax P, Bartáková H, et al. Long-term (up to 20 years) results of percutaneous balloon angioplasty of recurrent aortic coarctation without use of stents. Eur Heart J, 2008, 29(16): 2042-2048.
18. Gendera K, Ewert P, Tanase D, et al. Balloon-expandable stents for recoarctation of the aorta in small children. Two centre experience. Int J Cardiol, 2018, 263: 34-39.
19. Brzezinska-Rajszys G. Stents in treatment of aortic coarctation and recoarctation in small children. Int J Cardiol, 2018, 263: 40-41.
20. Sakopoulos AG, Hahn TL, Turrentine M, et al. Recurrent aortic coarctation: Is surgical repair still the gold standard? J Thorac Cardiovasc Surg, 1998, 116(4): 560-565.
21. Lefort B, Lachaud M, El Arid JM, et al. Immediate and midterm results of balloon angioplasty for recurrent aortic coarctation in children aged<1 year. Arch Cardiovasc Dis, 2018, 111(3): 172-179.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Outcomes of arch reintervention for post-repair recoarctation: A retrospectivel analysis in a single center

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