Two decades of aortic coarctation treatment in children; evaluating techniques
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Neth Heart J https://doi.org/10.1007/s12471-020-01513-y
Two decades of aortic coarctation treatment in children; evaluating techniques E. J. Dijkema · L. Dik · J. M. P. Breur · G. T. Sieswerda · F. Haas · M. G. Slieker · P. H. Schoof
Accepted: 20 October 2020 © The Author(s) 2020
Abstract Objective This study focuses on the evolution of treatment techniques for aortic coarctation in children and assesses long-term morbidity. Methods This retrospective cohort study evaluates patients treated for native aortic coarctation, with at least 7 years of follow-up. To assess time-related changes, three time periods were distinguished according to year of primary intervention (era 1, 2 and 3). Operative and long-term follow-up data were collected by patient record reviews. Results The study population consisted of 206 patients (177 surgical and 29 catheter-based interventions), with a median follow-up of 151 months. Anterior approach with simultaneous repair of aortic arch and associated cardiac lesions was more common in the most recent era. Median age at intervention did not change over time. Reintervention was necessary in one third of the cohort with an event-free survival of 74% at 5-year and 68% at 10-year follow-up. Reintervention rates were significantly higher after catheterbased interventions compared with surgical interventions (hazard ratio [HR] 1.8, 95% confidence interval E.J. Dijkema and L. Dik contributed equally to the manuscript. E. J. Dijkema () · L. Dik · J. M. P. Breur · M. G. Slieker Department of Pediatric Cardiology, Wilhelmina Children’s Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands [email protected] G. T. Sieswerda Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands F. Haas · P. H. Schoof Department of Cardiothoracic Surgery, Wilhelmina Children’s Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands
[CI] 1.04–3.00, p = 0.04) and in patients treated before 3 months of age (HR 2.1, 95% CI 1.27–3.55, p = 0.003). Hypertension was present in one out of five patients. Conclusion Nowadays, complex patients with associated cardiac defects and arch hypoplasia are being treated surgically on bypass, whereas catheterbased intervention is introduced for non-complex patients. Reintervention is common and more frequent after catheter-based intervention and in surgery under 3 months of age. One fifth of the 206 patients remained hypertensive. Keywords Congenital heart disease · Coarctation · Cardiothoracic surgery · Endovascular stent placement
Introduction Coarctation of the aorta (CoA) is a relatively common congenital anomaly, responsible for 5–10% of all congenital heart defects [1–3]. The first documented therapy for CoA was in 1945; surgical resection of the narrowed segment followed by end-to-end anastomosis [4]. Over the past decades surgical techniques What’s new?
Patients with more complex aortic coarctation and/or associated cardiac lesions are treated successfully with a more radical approach t
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