Karamlou Tara, Bernasconi Alessandra, Jaeggi Edgar, Alhabshan Fahad, Williams William G, Van Arsdell Glen S, Coles John G, Caldarone Christopher A
Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2009 May;137(5):1163-7. doi: 10.1016/j.jtcvs.2008.07.065. Epub 2009 Mar 17.
Neonates weighing less than 2.5 kg with aortic coarctation are challenging. We sought to find the prevalence of death or aortic arch reintervention and their determinants after coarctation repair. We also sought to define growth trajectories for postrepair aortic arch dimensions and identify factors associated with accelerated longitudinal growth.
We reviewed neonates weighing less than 2.5 kg undergoing coarctation repair between 1993 and 2004. Competing-risks methods determined time-related prevalences of death, arch reintervention, and survival without subsequent reintervention. Mixed regression analysis modeled longitudinal growth trajectories of echocardiographically derived aortic arch dimensions.
Thirty-six neonates underwent coarctation repair. Initial repair type was simple end to end (n = 3), extended end to end (n = 16), subclavian flap aortoplasty (n = 15), and patch aortoplasty (n = 2). Median initial repair age was 11 days (range 2-69 days) and mean weight was 2.01 +/- 0.33 kg. Overall 1-year survival was 76%. After 1 year from initial repair, 19% had died without subsequent reintervention, 14% underwent arch reintervention, and 67% remained alive without arch reintervention. Neonates with extended end-to-end repairs had increased transverse aortic arch Z-scores (P = .004). Although patients with larger initial transverse aortic arch Z-scores had higher scores across all time points (P < .001), neonates with the smallest transverse aortic arch Z-scores had accelerated growth trajectories (P < .001). Aortic isthmus growth was likewise accelerated in neonates with the smallest initial aortic isthmus Z-score (P < .001).
Mortality and arch reintervention are common after initial repair of coarctation of the aorta in neonates weighing less than 2.5 kg. Catch-up growth of both the transverse arch and isthmus occurs after coarctation repair, especially in those with the smallest arch parameters, and may be increased by using an extended end-to-end technique.
体重小于2.5 kg的主动脉缩窄新生儿治疗颇具挑战性。我们试图找出主动脉缩窄修复术后死亡或主动脉弓再次干预的发生率及其决定因素。我们还试图确定修复术后主动脉弓尺寸的生长轨迹，并识别与加速纵向生长相关的因素。
我们回顾了1993年至2004年间体重小于2.5 kg接受主动脉缩窄修复术的新生儿。竞争风险方法确定了死亡、主动脉弓再次干预以及无后续再次干预存活的时间相关发生率。混合回归分析对超声心动图得出的主动脉弓尺寸的纵向生长轨迹进行建模。
36例新生儿接受了主动脉缩窄修复术。初始修复类型为简单端端吻合术（n = 3）、延长端端吻合术（n = 16）、锁骨下动脉瓣主动脉成形术（n = 15）和补片主动脉成形术（n = 2）。初始修复的中位年龄为11天（范围2 - 69天），平均体重为2.01±0.33 kg。总体1年生存率为76%。初始修复1年后，19%的患儿未进行后续再次干预即死亡，14%接受了主动脉弓再次干预，67%存活且未进行主动脉弓再次干预。接受延长端端修复的新生儿的主动脉弓横向Z值增加（P = 0.004）。尽管初始主动脉弓横向Z值较大的患者在所有时间点的得分都较高（P < 0.001），但初始主动脉弓横向Z值最小的新生儿生长轨迹加速（P < 0.001）。初始主动脉峡部Z值最小的新生儿的主动脉峡部生长同样加速（P < 0.001）。
体重小于2.5 kg的新生儿主动脉缩窄初始修复术后死亡率和主动脉弓再次干预很常见。主动脉缩窄修复术后，主动脉弓横向和峡部均会出现追赶生长，尤其是在那些主动脉弓参数最小的患儿中，采用延长端端技术可能会增加这种生长。
