Dias Margarida Q, Barros António, Leite-Moreira Adelino, Miranda Joana O
Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
Pediatr Cardiol. 2020 Mar;41(3):561-575. doi: 10.1007/s00246-020-02319-w. Epub 2020 Feb 27.
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.
主动脉缩窄是一种常见的先天性心脏缺陷，通常需要在幼年时进行矫正。目前，成功的定义是实现持久修复，且发病率和死亡率较低。我们试图系统回顾1岁以下接受主动脉弓缩窄修复术的婴儿再缩窄和死亡风险因素的相关文献。检索了PubMed和Scopus数据库，查找1989年1月至2019年8月期间报告再缩窄和死亡风险因素的研究。在检索到的1038篇文章中，18篇符合纳入标准，共涉及2891例患者。提取的再缩窄风险因素综合归纳为以下几类：人口统计学变量、相关畸形、临床和修复变量以及形态学变量。年龄较小和体重较低是再次干预需求的弱决定因素，而主动脉弓较小是再缩窄的强预测因素。虽然球囊血管成形术是主动脉弓再狭窄的明确风险因素，但所选的手术技术并非强风险因素。相关的轻度心脏畸形和手术时体重较低是死亡的重要风险因素。年龄较小和体型较小的婴儿在接受主动脉弓缩窄修复术时不良结局风险增加。当与较小的主动脉弓形态相关时，这一点尤为重要。改善这些患者管理的策略可能在改善其结局方面发挥关键作用。值得注意的是，手术技术并非再缩窄和死亡的强预测因素，这表明在两者之间的选择应因人而异。
