Reintervention Burden and Vessel Growth After Surgical Reimplantation of a Pulmonary Artery During Childhood
| Autor: | Yoav Dori, Jonathan J. Rome, Stephan J. Wu, Tacy E. Downing, Matthew J. Gillespie, Christopher E. Mascio, Andrew C. Glatz |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Cardiac Catheterization medicine.medical_treatment Kaplan-Meier Estimate 030204 cardiovascular system & hematology Pulmonary Artery Single Center 03 medical and health sciences 0302 clinical medicine Postoperative Complications Risk Factors Internal medicine Angioplasty medicine.artery medicine Humans Stenosis Pulmonary Artery Tetralogy of Fallot Cardiac catheterization Retrospective Studies business.industry Hazard ratio Infant medicine.disease Cardiac surgery Stenosis Treatment Outcome 030228 respiratory system Echocardiography Child Preschool Replantation Pediatrics Perinatology and Child Health Pulmonary artery Cardiology Female Stents Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Pediatric cardiology. 39(2) |
| ISSN: | 1432-1971 |
| Popis: | Children requiring reimplantation of a branch pulmonary artery (PA) are at risk for postoperative stenosis and impaired growth of the reimplanted PA. Outcomes and risk factors for reintervention and impaired growth are incompletely described. We reviewed data on patients who underwent reimplantation of a branch PA between 1/1/99 and 5/1/15 at a single center. The primary outcome was reintervention to treat postoperative stenosis. The secondary outcome was “catch-up” growth (faster diameter growth of the affected PA compared with the unaffected PA from the preoperative to follow-up measurements.). Twenty-six patients were identified with a total follow-up of 102.2 patient-years (median 2.5 years). Diagnoses included LPA sling (n = 12) and isolated PA of ductal origin with (n = 7) or without (n = 7) tetralogy of Fallot (ToF). All had primary repair of the anomalous PA. Seventeen (65%) had reintervention with median time to first reintervention of 69 (range 1–1005) days and median of 1.5 (range 1–6) reinterventions. 94% of reinterventions were transcatheter (53% balloon and 41% stent angioplasty). Patients with reintervention were younger (hazard ratio 0.75 per log-day, p = 0.02) and lower weight (hazard ratio 0.18 per log-kg, p = 0.02) at initial repair. Of the 18 with PA growth data, 8 (44%) had catch-up growth. There were no identified differences between those who did and did not demonstrate catch-up growth. Despite a practice of primary reimplantation and aggressive postoperative reintervention, these results suggest that changes in strategy are needed or that there are intrinsic patient factors that have more influence on longer-term reimplanted PA growth. |
| Databáze: | OpenAIRE |
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