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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Reintervention for arch obstruction after stage 1 reconstruction does not adversely affect survival or outcome at
Jean A Ballweg1, Troy E Dominguez, Sarah Tabbutt
1Children's Hospital of Philadelphia, PA, USA. jballweg@uthsc.edu
Insights
Reintervention for coarctation after hypoplastic left heart syndrome reconstruction is common but does not impact Fontan completion or survival. However, it is linked to increased atrioventricular valve regurgitation.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Hypoplastic left heart syndrome (HLHS) requires staged surgical palliation.
- Coarctation of the aorta is a common complication after initial reconstruction.
- Reintervention for recurrent coarctation can impact subsequent surgical stages.
Purpose of the Study:
- To evaluate the outcomes of reintervention for coarctation post-stage 1 HLHS reconstruction.
- To assess the effect on survival, Fontan suitability, and Fontan-associated morbidity.
- To analyze the impact on long-term cardiac function and valve status.
Main Methods:
- Retrospective review of 176 patients undergoing stage 1 HLHS reconstruction (2002-2005).
- Analysis of echocardiograms, catheterizations, and hospital records.
- Kaplan-Meier survival analysis for patients alive >30 days post-stage 1.
Main Results:
- 23% of patients required reintervention for coarctation (balloon angioplasty or surgery).
- No significant difference in freedom from death or transplant between reintervention and no-reintervention groups.
- Increased atrioventricular valve regurgitation noted in patients requiring reintervention (28/33 vs 40/65).
- Fontan completion, mortality, and length of stay were similar between groups.
Conclusions:
- Reintervention for coarctation after stage 1 HLHS palliation is frequent.
- It does not adversely affect Fontan completion, mortality, or hospital stay.
- Longer-term outcomes require further investigation, particularly regarding valve function.
Objective:
To determine the effect of reintervention for coarctation after stage 1 reconstruction for hypoplastic left heart syndrome and variants on survival, suitability for Fontan, and morbidity at Fontan.
Methods:
A retrospective review of echocardiograms, catheterizations, hospital records of patients who underwent stage 1 reconstruction from January 2002 to May 2005, with a cross-sectional analysis of hospital survivors, was performed. Kaplan-Meier curves were derived for patients alive more than 30 days after stage 1 reconstruction.
Results:
A total of 176 patients underwent stage 1 reconstruction. Forty-three patients (23%) underwent balloon angioplasty (n = 43) or surgical intervention (n = 4) for re-coarctation. Median time to intervention was 123 (1-316) days. Seven of 43 patients (16%) underwent more than 1 balloon angioplasty. Thirty-nine patients underwent intervention before stage 2 reconstruction, and 4 patients had intervention between stage 2 reconstruction and Fontan. Kaplan-Meier curves showed no difference in freedom from death or transplant between patients who did and did not undergo intervention for re-coarctation. Fontan completion was performed in 107 patients. By echocardiogram, the prevalence of moderate to severe ventricular dysfunction between groups was similar at Fontan; however, significant atrioventricular valve regurgitation was more common in patients who required intervention (28/33 vs 40/65, P = .02). Overall Fontan mortality was 2% and not different between groups. Length of stay was not different between patients with and without re-coarctation.
Conclusions:
Reintervention for coarctation after stage 1 reconstruction is common. Hemodynamic differences between groups did not affect Fontan completion, mortality, or hospital length of stay. Follow-up is necessary to determine the impact of re-coarctation on longer-term mortality and morbidity.