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Balloon angioplasty of recoarctation of the neoaortic arch after the norwood operation: Factors affecting outcome and recurrence
Author(s) -
Bendaly Edgard A.,
Lane Kathleen A.,
Breinholt John P.
Publication year - 2012
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24436
Subject(s) - medicine , angioplasty , norwood procedure , balloon , surgery , aortic arch , logistic regression , aorta , hypoplastic left heart syndrome , heart disease
Background Balloon angioplasty (BA) is effective in relieving neoaorta recoarctation (reCoa) after the Norwood procedure. However, recurrence is not uncommon and risk factors for success and recurrence require further elucidation. We report the results of BA for reCoa following the Norwood procedure. We examine acute results and risk factors associated with success and recurrence after BA. Methods Patients who underwent BA between November 2000 and June 2010 were studied. Factors for immediate success and recurrence after BA were determined using logistic regression. Recurrence‐free survival was evaluated using the Kaplan–Meier curve. Results Forty‐seven angioplasties were performed in 39 patients. Mean age at catheterization was 5.0 ± 4.1 months. BA was successful in 40 angioplasties (85.1%). A higher preprocedure gradient across the coarctation ( P = 0.04) and a higher ratio of balloon to descending aorta ( P = 0.01) were associated with success. Six patients required redilation. Risk factors for recurrence included older age at Norwood ( P = 0.02), younger age ( P = 0.03), lower weight ( P = 0.04) and smaller body surface area at balloon angioplasty (BA) ( P = 0.04), and shorter duration between surgery and angioplasty ( P = 0.03). Freedom from recurrence from the first catheterization was 82% after 6 months and 78% after 1 year. There were no neurologic sequelae or deaths. Conclusions BA is effective acutely and long term with limited morbidity and mortality. Recurrence occurs usually within the first year. Delay in performing the initial angioplasty may be beneficial in reducing the risk of recurrence, but further study is needed. © 2012 Wiley Periodicals, Inc.