Procedural risk factors, incidence and timing of reintervention after treatment for native coarctation of the aorta in children: a population-based study†.

Autor:	Ylinen MK; Department of Pediatric Cardiology, Children`s Hospital, University Hospital and University of Helsinki, Helsinki, Finland.; Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland., Tyni VE; Department of Pediatric Cardiology, Children`s Hospital, University Hospital and University of Helsinki, Helsinki, Finland., Pihkala JI; Department of Pediatric Cardiology, Children`s Hospital, University Hospital and University of Helsinki, Helsinki, Finland., Salminen JT; Department of Pediatric Cardiology, Children`s Hospital, University Hospital and University of Helsinki, Helsinki, Finland., Sairanen H; Department of Pediatric Cardiology, Children`s Hospital, University Hospital and University of Helsinki, Helsinki, Finland., Sarkola T; Department of Pediatric Cardiology, Children`s Hospital, University Hospital and University of Helsinki, Helsinki, Finland.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2019 Mar 01; Vol. 55 (3), pp. 564-571.
DOI:	10.1093/ejcts/ezy252
Abstrakt:	Objectives: The aim of the present study was to evaluate procedural risk factors, incidence and timing of reintervention because of recurrent aortic coarctation in children. Methods: The study cohort consisted of 304 patients with isolated coarctation: 251 underwent surgery and 53 were treated percutaneously (40 balloon angioplasty, 13 stent) at the Helsinki Children's Hospital in 2000-2012. Characteristics, intervention and reintervention data were retrospectively collected from clinical records until 2014 (median follow-up 7.9 years). Age- and sex-matched comparisons between the treatment groups were performed in 86 patients (surgery n = 43, percutaneous n = 43). Results: Forty of the 251 (16%) patients after surgery, 9/40 (23%) patients after balloon angioplasty and 4/13 (31%) patients after stent placement underwent a reintervention after a median time of 3.4, 11.7 and 19.5 months (P < 0.05), respectively. In the surgery group, all reinterventions occurred in children operated on ≤12 months of age and were related to lower body weight and smaller dimensions of the aorta. In the balloon angioplasty group, a higher post-procedure systolic arm-leg blood pressure gradient was associated with reintervention. After stent placement, three-fourths of the reinterventions were performed in a planned postinterventional catheterization. In the age- and sex-matched comparisons (median 5,7 years, range 0,5-17,6), post-procedure blood pressure gradients were higher (mean 10 vs 4 mmHg, P = 0.03), and reinterventions were more common (28%, 95% confidence interval 17-43 vs 2%, 95% confidence interval 0-12) in the percutaneous group compared to the surgery group. Conclusions: Reinterventions after surgery in neonates were relatively common. In older children, percutaneous treatment carried a higher risk of reinterventions, which were mainly related to residual coarctation after primary treatment. (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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