Two decades of aortic coarctation treatment in children; evaluating techniques.

E J Dijkema,J M P Breur,L Dik,G T Sieswerda,F Haas,M G Slieker,P H Schoof

doi:10.1007/s12471-020-01513-y

Abstract

ObjectiveThis study focuses on the evolution of treatment techniques for aortic coarctation in children and assesses long-term morbidity.MethodsThis retrospective cohort study evaluates patients treated for native aortic coarctation, with at least 7 years of follow-up. To assess time-related changes, three time periods were distinguished according to year of primary intervention (era 1, 2 and 3). Operative and long-term follow-up data were collected by patient record reviews.ResultsThe study population consisted of 206 patients (177 surgical and 29 catheter-based interventions), with a median follow-up of 151 months. Anterior approach with simultaneous repair of aortic arch and associated cardiac lesions was more common in the most recent era. Median age at intervention did not change over time. Reintervention was necessary in one third of the cohort with an event-free survival of 74% at 5‑year and 68% at 10-year follow-up. Reintervention rates were significantly higher after catheter-based interventions compared with surgical interventions (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.04–3.00, p = 0.04) and in patients treated before 3 months of age (HR 2.1, 95% CI 1.27–3.55, p = 0.003). Hypertension was present in one out of five patients.ConclusionNowadays, complex patients with associated cardiac defects and arch hypoplasia are being treated surgically on bypass, whereas catheter-based intervention is introduced for non-complex patients. Reintervention is common and more frequent after catheter-based intervention and in surgery under 3 months of age. One fifth of the 206 patients remained hypertensive.

Highlights

Coarctation of the aorta (CoA) is a relatively common congenital anomaly, responsible for 5–10% of all congenital heart defects [1,2,3]
Nowadays, complex patients with associated cardiac defects and arch hypoplasia are being treated surgically on bypass, whereas catheterbased intervention is introduced for non-complex patients
Surgical treatment was performed in 177 patients (75 with end-to-end anastomosis, 29 with extended end-to-end anastomosis, 33 with patch angioplasty through lateral thoracotomy without use of extracorporeal circulation, 37 with aortic arch reconstruction through median sternotomy with use of extracorporeal circulation, hypothermia and selective antegrade cerebral perfusion and 3 with interposition graft) and catheter-based intervention in 29 patients (6 with and 23 without stent) (Fig. 1; Tab. 2)

Summary

Introduction

Coarctation of the aorta (CoA) is a relatively common congenital anomaly, responsible for 5–10% of all congenital heart defects [1,2,3]. The first documented therapy for CoA was in 1945; surgical resection of the narrowed segment followed by end-to-end anastomosis [4]. Over the past decades surgical techniques What’s new?. Patients with more complex aortic coarctation and/or associated cardiac lesions are treated successfully with a more radical approach to concomitant treatment of the aortic-arch. Age at referral has not changed over time. Despite evolution of treatment strategies need for reintervention remains frequent. Hypertension is common in long-term follow-up despite adequate treatment of coarctation

Methods

Results

Discussion

Conclusion