Echocardiographic predictors of recoarctation following surgical repair – a Swedish national study

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Echocardiographic predictors of recoarctation following surgical repair – a Swedish national study. / Weismann, Constance G.; Grell, Bernhard; Odermarsky, Michal; Mellander, Mats; Liuba, Petru.

I: Annals of Thoracic Surgery, Vol. 111, Nr. 4, 2021, s. 1380-1386.

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T1 - Echocardiographic predictors of recoarctation following surgical repair – a Swedish national study

AU - Weismann, Constance G.

AU - Grell, Bernhard

AU - Odermarsky, Michal

AU - Mellander, Mats

AU - Liuba, Petru

PY - 2021

Y1 - 2021

N2 - 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 Z-scores 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.

AB - 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 Z-scores 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.

U2 - 10.1016/j.athoracsur.2020.05.062

DO - 10.1016/j.athoracsur.2020.05.062

M3 - Article

C2 - 32619613

VL - 111

SP - 1380

EP - 1386

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 1552-6259

IS - 4

ER -