Rates of Interventions in Isolated Coarctation Repair in Neonates Versus Infants: Does Age Matter?
| Autor: | Frank A. Pigula, John E. Mayer, Pedro J. del Nido, Rinske IJsselhof, Meena Nathan, Kimberlee Gauvreau, Hua Liu |
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| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic arch Aortic valve Male medicine.medical_specialty Time Factors Aorta Thoracic 030204 cardiovascular system & hematology Aortic Coarctation law.invention 03 medical and health sciences 0302 clinical medicine Age Distribution Postoperative Complications law Intensive care Mitral valve medicine.artery medicine Humans Retrospective Studies business.industry Incidence Age Factors Infant Newborn Infant Retrospective cohort study Length of Stay medicine.disease Intensive care unit Hypoplasia United States Surgery medicine.anatomical_structure 030228 respiratory system Thoracotomy Cardiothoracic surgery Echocardiography Female Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures |
| Zdroj: | The Annals of thoracic surgery. 107(1) |
| ISSN: | 1552-6259 |
| Popis: | 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.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.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; p0.001) 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.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. |
| Databáze: | OpenAIRE |
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