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Risk Factors for Recoarctation and Mortality in Infants Submitted to Aortic Coarctation Repair: A Systematic Review

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Abstract

Aortic coarctation is a common congenital heart defect that often requires correction at a young age. Currently, success is defined by the achievement of a durable repair with low morbidity and mortality. We sought to systematically review the literature on risk factors for recoarctation and mortality in infants submitted to aortic arch coarctation repair under 1 year of age. PubMed and Scopus were searched for studies reporting risk factors for recoarctation and mortality from January 1989 to August 2019. Among the 1038 retrieved articles, 18 met the inclusion criteria, with a total of 2891 patients. The extracted risk factors for recoarctation were comprehensively summarized in the following categories: demographic variables, associated anomalies, clinical and repair variables, and morphometric variables. Younger age and lower weight were weak determinants of need for reintervention, while smaller aortic arch was a strong predictor of recoarctation. While balloon angioplasty is a clear risk factor for arch restenosis, the chosen surgical technique is not a strong risk factor. Associated minor cardiac anomalies and lower weight at surgery were important risk factors for death. Younger and smaller infants are at increased risk for adverse outcomes when submitted to aortic arch coarctation repair. This is particularly important when associated with smaller arch morphology. Strategies to improve the management of these patients may play a key role in improving their outcomes. Notably, surgical technique was not a strong predictor of recoarctation and mortality, suggesting that the choice of one over the other should be tailored.

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References

  1. Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJ, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E, Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of C, Association for European Paediatric C, Guidelines ESCCfP (2010) ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 31(23):2915–2957. https://doi.org/10.1093/eurheartj/ehq249

    Article  PubMed  Google Scholar 

  2. Becker AE, Becker MJ, Edwards JE (1970) Anomalies associated with coarctation of aorta: particular reference to infancy. Circulation 41(6):1067–1075. https://doi.org/10.1161/01.cir.41.6.1067

    Article  CAS  PubMed  Google Scholar 

  3. Ungerleider RM, Pasquali SK, Welke KF, Wallace AS, Ootaki Y, Quartermain MD, Williams DA, Jacobs JP (2013) Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 145(1):150–157. https://doi.org/10.1016/j.jtcvs.2012.09.053(discussion 157–158)

    Article  PubMed  Google Scholar 

  4. Backer CL, Mavroudis C, Zias EA, Amin Z, Weigel TJ (1998) Repair of coarctation with resection and extended end-to-end anastomosis. Ann Thorac Surg 66(4):1365–1370. https://doi.org/10.1016/s0003-4975(98)00671-7(discussion 1370–1361)

    Article  CAS  PubMed  Google Scholar 

  5. Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC (1989) Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation 80(4):840–845. https://doi.org/10.1161/01.cir.80.4.840

    Article  CAS  PubMed  Google Scholar 

  6. Dodge-Khatami A, Backer CL, Mavroudis C (2000) Risk factors for recoarctation and results of reoperation: a 40-year review. J Card Surg 15(6):369–377

    Article  CAS  Google Scholar 

  7. Gropler MRF, Marino BS, Carr MR, Russell WW, Gu H, Eltayeb OM, Monge MC, Backer CL (2019) Long-term outcomes of coarctation repair through left thoracotomy. Ann Thorac Surg 107(1):157–164. https://doi.org/10.1016/j.athoracsur.2018.07.027

    Article  PubMed  Google Scholar 

  8. Mery CM, Guzman-Pruneda FA, Trost JG Jr, McLaughlin E, Smith BM, Parekh DR, Adachi I, Heinle JS, McKenzie ED, Fraser CD Jr (2015) Contemporary results of aortic coarctation repair through left thoracotomy. Ann Thorac Surg 100(3):1039–1046. https://doi.org/10.1016/j.athoracsur.2015.04.129

    Article  PubMed  Google Scholar 

  9. Fiore AC, Fischer LK, Schwartz T, Jureidini S, Balfour I, Carpenter D, Demello D, Virgo KS, Pennington DG, Johnson RG (2005) Comparison of angioplasty and surgery for neonatal aortic coarctation. Ann Thorac Surg 80(5):1659–1664. https://doi.org/10.1016/j.athoracsur.2005.03.143(discussion 1664–1655)

    Article  PubMed  Google Scholar 

  10. Rodriguez Ogando A, Ballesteros Tejerizo F, Sarnago Cebada F, Medrano Lopez C, Gil Jaurena JM, Zunzunegui Martinez JL (2018) Experience with the absorb bioresorbable vascular scaffold in various scenarios of congenital heart disease. Rev Esp Cardiol 71(11):988–990. https://doi.org/10.1016/j.rec.2017.08.018

    Article  PubMed  Google Scholar 

  11. Zartner PA, Neudorf U, Bierbach B, Hart C, Schneider MB (2018) First follow-up of a breakable stent for implantation in infants dedicated for a life-long stay. Catheter Cardiovasc Interv 91(6):1119–1124. https://doi.org/10.1002/ccd.27543

    Article  PubMed  Google Scholar 

  12. Lehnert A, Villemain O, Gaudin R, Meot M, Raisky O, Bonnet D (2019) Risk factors of mortality and recoarctation after coarctation repair in infancy. Interact Cardiovasc Thorac Surg. https://doi.org/10.1093/icvts/ivz117

    Article  PubMed  Google Scholar 

  13. Burch PT, Cowley CG, Holubkov R, Null D, Lambert LM, Kouretas PC, Hawkins JA (2009) Coarctation repair in neonates and young infants: is small size or low weight still a risk factor? J Thorac Cardiovasc Surg 138(3):547–552. https://doi.org/10.1016/j.jtcvs.2009.04.046

    Article  PubMed  Google Scholar 

  14. McElhinney DB, Yang SG, Hogarty AN, Rychik J, Gleason MM, Zachary CH, Rome JJ, Karl TR, Decampli WM, Spray TL, Gaynor JW (2001) Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: is low weight a risk factor? J Thorac Cardiovasc Surg 122(5):883–890. https://doi.org/10.1067/mtc.2001.116316

    Article  CAS  PubMed  Google Scholar 

  15. Turek JW, Conway BD, Cavanaugh NB, Meyer AM, Aldoss O, Reinking BE, El-Hattab A, Rossi NP (2018) Bovine arch anatomy influences recoarctation rates in the era of the extended end-to-end anastomosis. J Thorac Cardiovasc Surg 155(3):1178–1183. https://doi.org/10.1016/j.jtcvs.2017.10.055

    Article  PubMed  Google Scholar 

  16. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151(4):W65–W94. https://doi.org/10.7326/0003-4819-151-4-200908180-00136

    Article  PubMed  Google Scholar 

  17. NIH Natinal Heart LaBI Study Quality Assessment Tools. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed Sept 2019

  18. Gorbatykh AV, Nichai NR, Ivantsov SM, Voitov AV, Kulyabin YY, Gorbatykh YN, Bogachev-Prokofiev AV (2017) Risk factors for aortic coarctation development in young children. Pediatria 96(3):118–124

    Article  Google Scholar 

  19. Adamson G, Karamlou T, Moore P, Natal-Hernandez L, Tabbutt S, Peyvandi S (2017) Coarctation index predicts recurrent aortic arch obstruction following surgical repair of coarctation of the aorta in infants. Pediatr Cardiol 38(6):1241–1246. https://doi.org/10.1007/s00246-017-1651-4

    Article  PubMed  Google Scholar 

  20. Chiu HH, Wang JK, Chen YS, Chiu IS, Chang CI, Lin MT, Lu CW, Chiu SN, Chen CA, Wu MH (2013) Long-term outcomes of native coarctation of the aorta after balloon angioplasty or surgical aortoplasty in newborns and young infants less than 3 months of age. Acta Cardiol Sin 29(2):168–174

    PubMed  PubMed Central  Google Scholar 

  21. Curzon CL, Milford-Beland S, Li JS, O’Brien SM, Jacobs JP, Jacobs ML, Welke KF, Lodge AJ, Peterson ED, Jaggers J (2008) Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 135(3):546–551. https://doi.org/10.1016/j.jtcvs.2007.09.068

    Article  PubMed  Google Scholar 

  22. Hager A, Schreiber C, Nutzl S, Hess J (2009) Mortality and restenosis rate of surgical coarctation repair in infancy: a study of 191 patients. Cardiology 112(1):36–41. https://doi.org/10.1159/000137697

    Article  PubMed  Google Scholar 

  23. Kalfa D, Krishnamurthy G, Duchon J, Najjar M, Levasseur S, Chai P, Chen J, Quaegebeur J, Bacha E (2014) Outcomes of cardiac surgery in patients weighing < 2.5 kg: affect of patient-dependent and -independent variables. J Thorac Cardiovasc Surg 148(6):2499–2506. https://doi.org/10.1016/j.jtcvs.2014.07.031

    Article  PubMed  PubMed Central  Google Scholar 

  24. Liang CD, Su WJ, Chung HT, Hwang MS, Huang CF, Lin YJ, Chien SJ, Lin IC, Ko SF (2009) Balloon angioplasty for native coarctation of the aorta in neonates and infants with congestive heart failure. Pediatr Neonatol 50(4):152–157. https://doi.org/10.1016/S1875-9572(09)60054-1

    Article  PubMed  Google Scholar 

  25. Quaegebeur JM, Jonas RA, Weinberg AD, Blackstone EH, Kirklin JW (1994) Outcomes in seriously ill neonates with coarctation of the aorta. A multiinstitutional study. J Thorac Cardiovasc Surg 108(5):841–851 (discussion 852–844)

    Article  CAS  Google Scholar 

  26. Ramachandran P, Khoury PR, Beekman RH, Michelfelder EC, Manning PB, Tweddell JS, Cnota JF (2018) Preoperative aortic arch size and late outcome after coarctation repair by lateral thoracotomy. Ann Thorac Surg 106(2):575–580. https://doi.org/10.1016/j.athoracsur.2018.03.084

    Article  PubMed  Google Scholar 

  27. Sen S, Garg S, Rao SG, Kulkarni S (2018) Native aortic coarctation in neonates and infants: immediate and midterm outcomes with balloon angioplasty and surgery. Ann Pediatr Cardiol 11(3):261–266. https://doi.org/10.4103/apc.APC_165_17

    Article  PubMed  PubMed Central  Google Scholar 

  28. Soynov I, Sinelnikov Y, Gorbatykh Y, Omelchenko A, Kornilov I, Nichay N, Bogachev-Prokophiev A, Karaskov A (2018) Modified reverse aortoplasty versus extended anastomosis in patients with coarctation of the aorta and distal arch hypoplasia. Eur J Cardiothorac Surg 53(1):254–261. https://doi.org/10.1093/ejcts/ezx249

    Article  PubMed  Google Scholar 

  29. Truong DT, Tani LY, Minich LL, Burch PT, Bardsley TR, Menon SC (2014) Factors associated with recoarctation after surgical repair of coarctation of the aorta by way of thoracotomy in young infants. Pediatr Cardiol 35(1):164–170. https://doi.org/10.1007/s00246-013-0757-6

    Article  PubMed  Google Scholar 

  30. Tulzer A, Mair R, Kreuzer M, Tulzer G (2016) Outcome of aortic arch reconstruction in infants with coarctation: importance of operative approach. J Thorac Cardiovasc Surg 152(6):1506–1513. https://doi.org/10.1016/j.jtcvs.2016.08.029

    Article  PubMed  Google Scholar 

  31. Welke KF, Diggs BS, Karamlou T, Ungerleider RM (2009) Comparison of pediatric cardiac surgical mortality rates from national administrative data to contemporary clinical standards. Ann Thorac Surg 87(1):216–222. https://doi.org/10.1016/j.athoracsur.2008.10.032

    Article  PubMed  Google Scholar 

  32. Slodki M, Rizzo G, Augustyniak A, Seligman NS, Zych-Krekora K, Respondek-Liberska M, International Prenatal Cardiology Collaboration G (2018) Retrospective cohort study of prenatally and postnatally diagnosed coarctation of the aorta (CoA): prenatal diagnosis improve neonatal outcome in severe CoA. J Matern Fetal Neonatal Med. https://doi.org/10.1080/14767058.2018.1510913

    Article  PubMed  Google Scholar 

  33. Gomez-Montes E, Herraiz I, Mendoza A, Escribano D, Galindo A (2013) Prediction of coarctation of the aorta in the second half of pregnancy. Ultrasound Obstet Gynecol 41(3):298–305. https://doi.org/10.1002/uog.11228

    Article  CAS  PubMed  Google Scholar 

  34. Russell GA, Berry PJ, Watterson K, Dhasmana JP, Wisheart JD (1991) Patterns of ductal tissue in coarctation of the aorta in the first three months of life. J Thorac Cardiovasc Surg 102(4):596–601

    CAS  PubMed  Google Scholar 

  35. Jonas RA (1991) Coarctation: do we need to resect ductal tissue? Ann Thorac Surg 52(3):604–607. https://doi.org/10.1016/0003-4975(91)90957-r

    Article  CAS  PubMed  Google Scholar 

  36. Adams EE, Davidson WR Jr, Swallow NA, Nickolaus MJ, Myers JL, Clark JB (2013) Long-term results of the subclavian flap repair for coarctation of the aorta in infants. World J Pediatr Congenit Heart Surg 4(1):13–18. https://doi.org/10.1177/2150135112466878

    Article  PubMed  Google Scholar 

  37. Fink C, Peuster M, Hausdorf G (2000) Endovascular stenting as an emergency treatment for neonatal coarctation. Cardiol Young 10(6):644–646

    Article  CAS  Google Scholar 

  38. Grohmann J, Sigler M, Siepe M, Stiller B (2016) A new breakable stent for recoarctation in early infancy: preliminary clinical experience. Catheter Cardiovasc Interv 87(4):E143–E150. https://doi.org/10.1002/ccd.26393

    Article  PubMed  Google Scholar 

  39. Usman MH, Rengifo-Moreno P, Janzer SF, Inglessis-Azuaje I, Witzke-Sanz C (2014) Coarctation of the aorta: management, indications for intervention, and advances in care. Curr Treat Options Cardiovasc Med 16(10):341. https://doi.org/10.1007/s11936-014-0341-2

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, University of Porto, Porto, Portugal

    Margarida Q. Dias

  2. Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal

    António Barros, Adelino Leite-Moreira & Joana O. Miranda

  3. Cardiovascular R&D Centre (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal

    António Barros, Adelino Leite-Moreira & Joana O. Miranda

  4. Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal

    Adelino Leite-Moreira

  5. Department of Pediatric Cardiology, São João Hospital Centre, Porto, Portugal

    Joana O. Miranda

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  1. Margarida Q. Dias
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  4. Joana O. Miranda
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Contributions

MD and JM designed the study. MD and JM worked equally in study selection, data collection and assessed the quality of included studies. MD drafted the manuscript. MD, JM, ALM, and AB revised the manuscript. All authors reviewed and approved the final manuscript.

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Correspondence to Margarida Q. Dias.

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Dias, M.Q., Barros, A., Leite-Moreira, A. et al. Risk Factors for Recoarctation and Mortality in Infants Submitted to Aortic Coarctation Repair: A Systematic Review. Pediatr Cardiol 41, 561–575 (2020). https://doi.org/10.1007/s00246-020-02319-w

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