Rates of Interventions in Isolated Coarctation Repair in Neonates Versus Infants: Does Age Matter?

Autor:	IJsselhof R; University Medical Center Utrecht, Utrecht, The Netherlands., Liu H; Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts., Pigula F; Florida Hospital Medical Group, Orlando, Florida., Gauvreau K; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts., Mayer JE; Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts., Nido PD; Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts., Nathan M; Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: meena.nathan@cardio.chboston.org.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2019 Jan; Vol. 107 (1), pp. 180-186. Date of Electronic Publication: 2018 Sep 01.
DOI:	10.1016/j.athoracsur.2018.07.016
Abstrakt:	Background: In the current era, coarctation repair is usually performed as soon as diagnosis is established. We sought to determine if neonatal isolated coarctation repair had a higher rate of intervention postdischarge when compared with older infants. Methods: We conducted a retrospective review of neonates (≤30 days of age) and infants (1 to 6 months of age) undergoing isolated coarctation repair between January 1, 2000, and March 31, 2016. Preoperative and postoperative Z scores of arch, aortic valve, and isthmus; rates of reintervention; and length of stay (LOS) were compared between groups. Linear or Cox regression was used to determine predictors of postoperative intensive care unit and hospital LOS during index surgery and postdischarge interventions for the entire cohort. Results: There were 213 (71.5%) neonates and 85 (28.5%) infants. There was no difference in aortic valve morphology between groups. There was a trend but no statistical difference in postdischarge coarctation reintervention (neonates 10.3% versus infants 4.7%; p = 0.1) or left ventricular outflow tract, aortic valve, or mitral valve interventions (9.9% versus 9.4%; p = 0.9). Median postoperative intensive care LOS (3.01 versus 2.28 days; p < 0.001) and postoperative hospital LOS (6.23 versus 4.85 days; p < 0.001) were significantly higher in neonates. Median follow-up was 3 (interquartile range, 0.2 to 9) years for the entire cohort. On multivariable modeling, preoperative hypoplastic arch was associated with arch reinterventions, particularly in infants (10%; p = 0.003). Preoperative left-sided catheter intervention, left-sided obstructive lesions, and age predicted postdischarge intervention on left-sided structures. Conclusions: Coarctation repair can be safely performed in infants and neonates with acceptable postdischarge intervention. Severity of aortic arch hypoplasia is an important discriminator for reinterventions on the arch, particularly in infants. (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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