Echocardiographic predictors of recoarctation following surgical repair – a Swedish national study
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Background: Following surgical repair of aortic coarctation (CoA) there is a risk for restenosis (reCoA), particularly in the first year of life. It was the aim of this study to identify reCoA risk factors by analyzing postoperative pre-discharge echocardiograms. Methods: Retrospective analysis of echocardiograms of children born operated for CoA in Sweden 2011-2017. Results: 253 children were included; median age at surgery 10 days; median follow-up 4.6 years. ReCoA occurred in 34 patients (13%; 74% by 6 months, 91% by 12 months). We generated two reCoA risk models applying a) aortic dimensions and b) the respective Zscores combined with surgical and demographic factors. We defined reCoA risk categories as low (<10%), moderate (11-29%), moderate-high (30-49%) and high (>50%). Patients with a) isthmus >3.3mm (1- and 5-year event free survival 38 and 32%) or b) isthmus Z-score >- 2.8 with a weight at surgery <4.4kg (1- and 5-year event free survival 21 and 16%) were at highest risk for reCoA. Conversely, patients at low risk had a) isthmus >3.7mm and distal aortic arch >3.5mm (1- and 5-year event free survival 97 and 97%), and b) isthmus and proximal aortic arch Z-score >-2.8 or operative weight >4.4kg with an isthmus Z-score <=-2.8 with (1- and 5-year event free survival 97 and 97%). Conclusion: ReCoA risk can be predicted based on postoperative pre-discharge echocardiographic variables in combination with surgical and demographic factors. We suggest tailoring follow-up intervals individually according to the predicted reCoA risk.
|Enheter & grupper|
Ämnesklassifikation (UKÄ) – OBLIGATORISK
|Tidskrift||Annals of Thoracic Surgery|
|Status||Accepted/In press - 2020 jun 30|
|Peer review utförd||Ja|