RECOARCTATION AFTER SURGICAL CORRECTION OF COARCTATION OF THE AORTA IN CHILDREN AND ADOLESCENTS
Keywords:
coarctation of the aorta, recoarctation, risk factors, gradient
Abstract
Introduction: Coarctation of the aorta (CoA) is a narrowing of the thoracic aorta, most often localized at the junction of ductus arteriosus. Data on risk factors for the development of recoarctation remain contradictory in literature.
The aim: To determine the frequency of recoarctation and to identify risk factors for the recoarctation after surgical correction of CoA.
Material and methods: The research included 94 patients who underwent surgery for coarctation of the aorta from 2012 to 2017. Demographic and clinical characteristics, preoperative, intraoperative, postoperative and echocardiographic parameters were observed. Pressure gradient over 25 mmHg immediately after operation is considered predictоr for recoarctation of the aorta. The data was processed using methods of descriptive and analytical statistics.
Results: The median age at the time of surgery was 2 months (4 days-19 years). The dominant technique was extended end-to-end anastomosis (90.4%). Kaplan Meier survival analysis showed higher incidence of recoarctation in the group of patients with immediate postoperative gradient >25 mmHg (p<0.001). Also, Cox logistic regression showed higher immediate postoperative gradient to be a predictor (HR 4.57, p=0.009, 95% CI 1.47 -14.22). After correction for other cofactors, including sex, genetic syndrome, small body weight, administration of prostaglandine E1, presence of bicuspid aortic valve, surgical technique, it was shown that group of patients with higher immediate postoperative gradient has 4-fold higher probability for recoarctation (HR 4.37, p=0.035, 95% CI 1,11 -17,16) .
Conclusion: Immediate postoperative pressure gradient > 25 mmHg is an independent predictor for recoarctation after surgical correction of the coarctation of the aorta.
References
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Cardiovascular Magnetic Resonance Imaging to a Tertiary Center. Pediatr Cardiol 32,1120– 1127 (2011).
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3. Anderson RH, Lenox CC, Zuberbuhler JR. Morphology of ventricular septal defect associated with coarctation of aorta. Br Heart J. 1983 Aug;50(2):176-81.
4. Shinebourne EA, Tam AS, Elseed AM, Paneth M, Lennox SC, Cleland WP. Coarctation of the aorta in infancy and childhood. Br Heart J. 1976 Apr;38(4):375-80.
5. SHONE JD, SELLERS RD, ANDERSON RC, ADAMS P Jr, LILLEHEI CW, EDWARDS JE. The developmental complex of "parachute mitral valve," supravalvular ring of left atrium, subaortic stenosis, and coarctation of aorta. Am J Cardiol. 1963 Jun;11:714-25
6. Warnes CA. Bicuspid aortic valve and coarctation: two villains part of a diffuse problem. Heart. 2003 Sep;89(9):965-6.
7. Becker AE, Becker MJ, Edwards JE. Anomalies associated with coarctation of aorta: particular reference to infancy. Circulation. 1970 Jun;41(6):1067-75
8. IJsselhof R, Liu H, Pigula F, Gauvreau K, Mayer JE, Nido PD, Nathan M. Rates of Interventions in Isolated Coarctation Repair in Neonates Versus Infants: Does Age Matter? Ann Thorac Surg. 2019 Jan;107(1):180-186.
9. Dodge-Khatami A, Backer CL, Mavroudis C. Risk factors for recoarctation and results of reoperation: a 40-year review. J Card Surg. 2000 Nov-Dec;15(6):369-77.
10. Freed MD, Heymann MA, Lewis AB, Roehl SL, Kensey RC. Prostaglandin E1 infants with ductus arteriosus-dependent congenital heart disease. Circulation. 1981 Nov;64(5):899-905.
11. Salahuddin N, Wilson AD, Rao PS. An unusual presentation of coarctation of the aorta in infancy: role of balloon angioplasty in the critically ill infant. Am Heart J. 1991 Dec;122(6):1772-5.
12. Choudhary P, Canniffe C, Jackson DJ, Tanous D, Walsh K, Celermajer DS. Late outcomes in adults with coarctation of the aorta. Heart. 2015 Aug;101(15):1190-5.
13. Brown ML, Burkhart HM, Connolly HM, Dearani JA, Cetta F, Li Z, Oliver WC, Warnes CA, Schaff HV. Coarctation of the aorta: lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol. 2013 Sep 10;62(11):1020-5.
14. Roifman I, Therrien J, Ionescu-Ittu R, Pilote L, Guo L, Kotowycz MA, Martucci G, Marelli AJ. Coarctation of the aorta and coronary artery disease: fact or fiction? Circulation. 2012 Jul 3;126(1):16-21.
15. Egbe AC, Rihal CS, Thomas A, Boler A, Mehra N, Andersen K, Kothapalli S, Taggart NW, Connolly HM. Coronary Artery Disease in Adults With Coarctation of Aorta: Incidence, Risk Factors, and Outcomes. J Am Heart Assoc. 2019 Jun 18;8(12):e012056.
16. McElhinney DB, Yang SG, Hogarty AN, Rychik J, Gleason MM, Zachary CH, Rome JJ, Karl TR, Decampli WM, Spray TL, Gaynor JW. Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: is low weight a risk factor? J Thorac Cardiovasc Surg. 2001 Nov;122(5):883-90.
17. Burch PT, Cowley CG, Holubkov R, Null D, Lambert LM, Kouretas PC, Hawkins JA. Coarctation repair in neonates and young infants: is small size or low weight still a risk factor? J Thorac Cardiovasc Surg. 2009 Sep;138(3):547-52.
18. Kecskes Z, Cartwright DW. Poor outcome of very low birthweight babies with serious congenital heart disease. Arch Dis Child Fetal Neonatal Ed. 2002 Jul;87(1):F31-3.
19. Karamlou T, Bernasconi A, Jaeggi E, Alhabshan F, Williams WG, Van Arsdell GS, Coles JG, Caldarone CA. Factors associated with arch reintervention and growth of the aortic arch after coarctation repair in neonates weighing less than 2.5 kg. J Thorac Cardiovasc Surg. 2009 May;137(5):1163-7.
20. Conte S, Lacour-Gayet F, Serraf A, Sousa-Uva M, Bruniaux J, Touchot A, Planché C. Surgical management of neonatal coarctation. J Thorac Cardiovasc Surg. 1995 Apr;109(4):663-74; discussion 674-5.
21. Lehnert A, Villemain O, Gaudin R, Méot M, Raisky O, Bonnet D. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact Cardiovasc Thorac Surg. 2019 Sep 1;29(3):469-475.
22. Gorbatykh AV, Nichai NR, Ivantsov SM, Voitov AV, Kulyabin YY, Gorbatykh YN,Bogachev-Prokofiev AV (2017) Risk factors for aortic coarctation development in young children. Pediatria 96(3):118–124
23. 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 Aug;38(6):1241-1246.
24. Liang CD, Su WJ, Chung HT, Hwang MS, Huang CF, Lin YJ, Chien SJ, Lin IC, Ko SF. Balloon angioplasty for native coarctation of the aorta in neonates and infants with congestive heart failure. Pediatr Neonatol. 2009 Aug;50(4):152-7.
25. 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 Mar;41(3):561-575.
26. 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: 158-63.
27. Lupoglazoff JM, Hubert P, Labenne M, Sidi D, Kachaner J. Therapeutic strategy in newborn infants with multivisceral failure caused by interruption or hypoplasia of the aortic arch. Arch Mal Coeur Vaiss 1995;88:725–30.
28. Kaushal S, Backer CL, Patel JN, Patel SK, Walker BL, Weigel TJ,Randolph G, Wax D, Mavroudis C. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg 2009; 88: 1932-1938.
29. Thomson JD, Mulpur A, Guerrero R, Nagy Z, Gibbs JL, Watterson KG. Outcome after extended arch repair for aortic coarctation. Heart 2006; 92: 90-94.
30. Wright GE, Nowak CA, Goldberg CS, Ohye RG, Bove EL, Rocchini AP. Extended resection and end-to-end anastomosis for aortic coarctation in infants: results of a tailored surgical approach. Ann Thorac Surg 2005; 80: 1453-1459.
31. Amato JJ, Rheinlander HF, Cleveland RJ. A method of enlarging the distal transverse arch in infants with hypoplasia and coarctationof the aorta. Ann Thorac Surg 1977; 23: 261-263.
32. Canniffe C, Ou P, Walsh K, Bonnet D, Celermajer D. Hypertension after repair of aortic coarctation–a systematic review. Int J Cardiol 2013;167: 2456–61.
33. Schafer M, Morgan GJ, Mitchell MB, et al. Impact of different coarctation therapies on aortic stiffness:phase-contrast MRI study. Int J Cardiovasc Imaging 2018;34(9):1459–69.
34. Martins JD, Zachariah J, Selamet Tierney ES, et al. Impact of treatment modality on vascular function in coarctation of the aorta: the LOVE - COARCT Study. J Am Heart Assoc 2019;8(7):e011536.
35. Morgan GJ, Lee KJ, Chaturvedi R, Bradley TJ, Mertens L, Benson L. Systemic blood pressure after stent management for arch coarctation implications for clinical care. JACC Cardiovasc Interv 2013; 6: 192-201;
36. Kim YY, Andrade L, Cook SC. Aortic Coarctation. Cardiol Clin. 2020 Aug;38(3):337-351;
37. Eldadah OM, Alsalmi AA, Diraneyya OM, Hrfi AA, Mohammed MHA, Valls ML, Alghamdi AA. Progressive changes in residual gradient after aortic coarctation repair and its role in the prediction of reintervention: A longitudinal data analysis. Ann Pediatr Cardiol. 2023 May-Jun;16(3):182-188.
Cardiovascular Magnetic Resonance Imaging to a Tertiary Center. Pediatr Cardiol 32,1120– 1127 (2011).
2. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002 Jun 19;39(12):1890-900.
3. Anderson RH, Lenox CC, Zuberbuhler JR. Morphology of ventricular septal defect associated with coarctation of aorta. Br Heart J. 1983 Aug;50(2):176-81.
4. Shinebourne EA, Tam AS, Elseed AM, Paneth M, Lennox SC, Cleland WP. Coarctation of the aorta in infancy and childhood. Br Heart J. 1976 Apr;38(4):375-80.
5. SHONE JD, SELLERS RD, ANDERSON RC, ADAMS P Jr, LILLEHEI CW, EDWARDS JE. The developmental complex of "parachute mitral valve," supravalvular ring of left atrium, subaortic stenosis, and coarctation of aorta. Am J Cardiol. 1963 Jun;11:714-25
6. Warnes CA. Bicuspid aortic valve and coarctation: two villains part of a diffuse problem. Heart. 2003 Sep;89(9):965-6.
7. Becker AE, Becker MJ, Edwards JE. Anomalies associated with coarctation of aorta: particular reference to infancy. Circulation. 1970 Jun;41(6):1067-75
8. IJsselhof R, Liu H, Pigula F, Gauvreau K, Mayer JE, Nido PD, Nathan M. Rates of Interventions in Isolated Coarctation Repair in Neonates Versus Infants: Does Age Matter? Ann Thorac Surg. 2019 Jan;107(1):180-186.
9. Dodge-Khatami A, Backer CL, Mavroudis C. Risk factors for recoarctation and results of reoperation: a 40-year review. J Card Surg. 2000 Nov-Dec;15(6):369-77.
10. Freed MD, Heymann MA, Lewis AB, Roehl SL, Kensey RC. Prostaglandin E1 infants with ductus arteriosus-dependent congenital heart disease. Circulation. 1981 Nov;64(5):899-905.
11. Salahuddin N, Wilson AD, Rao PS. An unusual presentation of coarctation of the aorta in infancy: role of balloon angioplasty in the critically ill infant. Am Heart J. 1991 Dec;122(6):1772-5.
12. Choudhary P, Canniffe C, Jackson DJ, Tanous D, Walsh K, Celermajer DS. Late outcomes in adults with coarctation of the aorta. Heart. 2015 Aug;101(15):1190-5.
13. Brown ML, Burkhart HM, Connolly HM, Dearani JA, Cetta F, Li Z, Oliver WC, Warnes CA, Schaff HV. Coarctation of the aorta: lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol. 2013 Sep 10;62(11):1020-5.
14. Roifman I, Therrien J, Ionescu-Ittu R, Pilote L, Guo L, Kotowycz MA, Martucci G, Marelli AJ. Coarctation of the aorta and coronary artery disease: fact or fiction? Circulation. 2012 Jul 3;126(1):16-21.
15. Egbe AC, Rihal CS, Thomas A, Boler A, Mehra N, Andersen K, Kothapalli S, Taggart NW, Connolly HM. Coronary Artery Disease in Adults With Coarctation of Aorta: Incidence, Risk Factors, and Outcomes. J Am Heart Assoc. 2019 Jun 18;8(12):e012056.
16. McElhinney DB, Yang SG, Hogarty AN, Rychik J, Gleason MM, Zachary CH, Rome JJ, Karl TR, Decampli WM, Spray TL, Gaynor JW. Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: is low weight a risk factor? J Thorac Cardiovasc Surg. 2001 Nov;122(5):883-90.
17. Burch PT, Cowley CG, Holubkov R, Null D, Lambert LM, Kouretas PC, Hawkins JA. Coarctation repair in neonates and young infants: is small size or low weight still a risk factor? J Thorac Cardiovasc Surg. 2009 Sep;138(3):547-52.
18. Kecskes Z, Cartwright DW. Poor outcome of very low birthweight babies with serious congenital heart disease. Arch Dis Child Fetal Neonatal Ed. 2002 Jul;87(1):F31-3.
19. Karamlou T, Bernasconi A, Jaeggi E, Alhabshan F, Williams WG, Van Arsdell GS, Coles JG, Caldarone CA. Factors associated with arch reintervention and growth of the aortic arch after coarctation repair in neonates weighing less than 2.5 kg. J Thorac Cardiovasc Surg. 2009 May;137(5):1163-7.
20. Conte S, Lacour-Gayet F, Serraf A, Sousa-Uva M, Bruniaux J, Touchot A, Planché C. Surgical management of neonatal coarctation. J Thorac Cardiovasc Surg. 1995 Apr;109(4):663-74; discussion 674-5.
21. Lehnert A, Villemain O, Gaudin R, Méot M, Raisky O, Bonnet D. Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact Cardiovasc Thorac Surg. 2019 Sep 1;29(3):469-475.
22. Gorbatykh AV, Nichai NR, Ivantsov SM, Voitov AV, Kulyabin YY, Gorbatykh YN,Bogachev-Prokofiev AV (2017) Risk factors for aortic coarctation development in young children. Pediatria 96(3):118–124
23. 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 Aug;38(6):1241-1246.
24. Liang CD, Su WJ, Chung HT, Hwang MS, Huang CF, Lin YJ, Chien SJ, Lin IC, Ko SF. Balloon angioplasty for native coarctation of the aorta in neonates and infants with congestive heart failure. Pediatr Neonatol. 2009 Aug;50(4):152-7.
25. 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 Mar;41(3):561-575.
26. 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: 158-63.
27. Lupoglazoff JM, Hubert P, Labenne M, Sidi D, Kachaner J. Therapeutic strategy in newborn infants with multivisceral failure caused by interruption or hypoplasia of the aortic arch. Arch Mal Coeur Vaiss 1995;88:725–30.
28. Kaushal S, Backer CL, Patel JN, Patel SK, Walker BL, Weigel TJ,Randolph G, Wax D, Mavroudis C. Coarctation of the aorta: midterm outcomes of resection with extended end-to-end anastomosis. Ann Thorac Surg 2009; 88: 1932-1938.
29. Thomson JD, Mulpur A, Guerrero R, Nagy Z, Gibbs JL, Watterson KG. Outcome after extended arch repair for aortic coarctation. Heart 2006; 92: 90-94.
30. Wright GE, Nowak CA, Goldberg CS, Ohye RG, Bove EL, Rocchini AP. Extended resection and end-to-end anastomosis for aortic coarctation in infants: results of a tailored surgical approach. Ann Thorac Surg 2005; 80: 1453-1459.
31. Amato JJ, Rheinlander HF, Cleveland RJ. A method of enlarging the distal transverse arch in infants with hypoplasia and coarctationof the aorta. Ann Thorac Surg 1977; 23: 261-263.
32. Canniffe C, Ou P, Walsh K, Bonnet D, Celermajer D. Hypertension after repair of aortic coarctation–a systematic review. Int J Cardiol 2013;167: 2456–61.
33. Schafer M, Morgan GJ, Mitchell MB, et al. Impact of different coarctation therapies on aortic stiffness:phase-contrast MRI study. Int J Cardiovasc Imaging 2018;34(9):1459–69.
34. Martins JD, Zachariah J, Selamet Tierney ES, et al. Impact of treatment modality on vascular function in coarctation of the aorta: the LOVE - COARCT Study. J Am Heart Assoc 2019;8(7):e011536.
35. Morgan GJ, Lee KJ, Chaturvedi R, Bradley TJ, Mertens L, Benson L. Systemic blood pressure after stent management for arch coarctation implications for clinical care. JACC Cardiovasc Interv 2013; 6: 192-201;
36. Kim YY, Andrade L, Cook SC. Aortic Coarctation. Cardiol Clin. 2020 Aug;38(3):337-351;
37. Eldadah OM, Alsalmi AA, Diraneyya OM, Hrfi AA, Mohammed MHA, Valls ML, Alghamdi AA. Progressive changes in residual gradient after aortic coarctation repair and its role in the prediction of reintervention: A longitudinal data analysis. Ann Pediatr Cardiol. 2023 May-Jun;16(3):182-188.
Published
2025/10/30
Section
Original Scientific Paper