Introduction
Methods
Study population
Overall | Group 1 | Group 2 | Group 3 | p-value | ||
---|---|---|---|---|---|---|
(1987–1994) | (1995–2002) | (2003–2010) | ||||
n = 206 | n = 59 | n = 58 | n = 89 | |||
Age at intervention (days) | 30 (2–6413) | 35 (2–5579) | 28 (4–5231) | 26 (5–6413) | 0.54 | |
Infants | 159 (77%) | 48 (81%) | 46 (79%) | 65 (73%) | 0.45 | |
Young children | 36 (17%) | 10 (17%) | 9 (16%) | 17 (19%) | 0.85 | |
Adolescents | 11 (5%) | 1 (2%) | 3 (5%) | 7 (8%) | 0.26 | |
Intervention <3 months of age | 135 (66%) | 40 (68%) | 38 (66%) | 57 (64%) | 0.90 | |
Age at study (years) | 15.5 (7.0–35.5) | 22.7 (7.0–30.8) | 17.4 (7.0–35.5) | 11.0 (7.0–25.3) | <0.01 | |
Sex (male) | 137 (67%) | 36 (61%) | 42 (72%) | 57 (64%) | 0.93 | |
Follow-up (months) | 152 (75–347) | 268 (83–347) | 205 (79–274) | 117 (75–166) | <0.01 | |
Associated lesions | 147 (71%) | 42 (71%) | 38 (65%) | 67(75%) | 0.38 | |
Bicuspid aortic valve | 80 (39%) | 22 (37%) | 22 (38%) | 36 (40%) | 0.92 | |
Hypoplastic aortic arch | 43 (21%) | 6 (10%) | 8 (14%) | 29 (33%) | <0.01 | |
Ventricular septal defect | 78 (38%) | 24 (41%) | 19 (33%) | 35 (39%) | 0.63 | |
Patent ductus arteriosus | 44 (21%) | 16 (27%) | 3 (5%) | 25 (28%) | <0.01 | |
Haemodynamically significant comorbiditya | 114 (55%) | 31 (53%) | 23 (40%) | 59 (66%) | <0.01 |
Treatment strategies
Follow-up data
Statistical analysis
Results
Study population
Overall | Group 1 | Group 2 | Group 3 | p-value | |
---|---|---|---|---|---|
(1987–1994) | (1995–2002) | (2003–2010) | |||
n = 206 | n = 59 | n = 58 | n = 89 | ||
End-to-end anastomosis | 104 (50%) | 25 (42%) | 31 (54%) | 48 (54%) | 0.34 |
Patch angioplasty | 33 (16%) | 25 (42%) | 6 (10%) | 2 (2%) | <0.001 |
Aortic arch reconstruction | 37 (18%) | 2 (4%) | 6 (10%) | 29 (33%) | <0.001 |
Interposition graft | 3 (1%) | – | – | 3 (3%) | NA |
Balloon angioplasty alone | 23 (11%) | 7 (12%) | 15 (26%) | 1 (1%) | <0.001 |
Balloon + stent placement | 6 (3%) | – | – | 6 (7%) | NA |
Treatment
Overall | Surgery | Endovascular | |
---|---|---|---|
n = 206 | n = 177 | n = 29 | |
Infant (0–1 yr) | 159 | 150 (94%) | 9 (6%) |
Young (1–10 yr) | 36 | 22 (61%) | 14 (39%) |
Adolescent (10–18 yr) | 11 | 5 (45%) | 6 (55%) |
Follow-up
Overall | Group 1 | Group 2 | Group 3 | P-value | ||
---|---|---|---|---|---|---|
(n = 206) | (n = 59) | (n = 58) | (n = 89) | |||
Reintervention | 83 (40%) | 21 (36%) | 31 (53%) | 32 (36%) | 0.07 | |
Hypertension | 42 (20%) | 14 (24%) | 14 (24%) | 14 (16%) | 0.35 | |
Aneurysm formation | ||||||
CT or MR imaging | 86 (42%) | 35 (59%) | 30 (52%) | 21 (24%) | <0.01 | |
Aneurysm found | 7 (8%) | 2 (6%) | 3 (10%) | 2 (10%) | 0.80 |
Reintervention
Hypertension
Aneurysms
Discussion
Treatment
Follow-up
Limitations
Conclusion
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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.
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Despite improved diagnosis, age at referral has not changed over time.
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Despite evolution of treatment strategies need for reintervention remains frequent.
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Hypertension is common in long-term follow-up despite adequate treatment of coarctation.