Department of Clinical Sciences Lund, Pediatric Cardiology, Lund University, Skane University Hospital, Lund, Sweden.
Department of Clinical Sciences Lund, Pediatric Cardiology, Lund University, Skane University Hospital, Lund, Sweden.
Ann Thorac Surg. 2021 Apr;111(4):1380-1386. doi: 10.1016/j.athoracsur.2020.05.062. Epub 2020 Jun 30.
After surgical repair of aortic coarctation (CoA) there is a risk for restenosis (reCoA), particularly in the first year of life. This study aimed to identify reCoA risk factors by analyzing postoperative predischarge echocardiograms.
This was a retrospective analysis of echocardiograms of children born operated on for CoA in Sweden in 2011 to 2017.
A total of 253 children were included. Median age at surgery was 10 days; median follow-up was 4.6 years. Risk for restenosis occurred in 34 patients (13%; 74% by 6 months and 91% by 12 months). We generated 2 reCoA risk models applying aortic dimensions and the respective Z-scores combined with surgical and demographic factors. We defined reCoA risk categories as low (≤10%), moderate (11% to 29%), moderate to high (30% to 49%), or high (≥50%). Patients with either isthmus of 3.3 mm or less (1- and 5-year event-free survival of 38% and 32%, respectively) or isthmus Z-score of -2.8 or less with a weight at surgery of less than 4.4 kg (1- and 5-year event free survival of 21% and 16%, respectively) were at highest risk for reCoA. Conversely, patients at low risk had isthmus greater than 3.7 mm and distal aortic arch greater than 3.5mm (1- and 5-year event free survival of 97% and 97%, respectively), and isthmus and proximal aortic arch Z-score greater than -2.8 or operative weight greater than 4.4 kg with an isthmus Z-score of -2.8 or less (1- and 5-year event-free survival of 97% and 97%, respectively).
Risk for reCoA can be predicted based on postoperative predischarge echocardiographic variables combined with surgical and demographic factors. We suggest tailoring follow-up intervals individually according to the predicted reCoA risk.
主动脉缩窄（CoA）手术后存在再狭窄（reCoA）的风险，尤其是在生命的第一年。本研究旨在通过分析术后出院前的超声心动图来确定再狭窄的危险因素。
这是一项对 2011 年至 2017 年在瑞典接受手术治疗的 CoA 患儿术后超声心动图的回顾性分析。
共纳入 253 例患儿。手术时的中位年龄为 10 天；中位随访时间为 4.6 年。34 例（13%；74%在 6 个月时，91%在 12 个月时）发生再狭窄风险。我们生成了 2 个再狭窄风险模型，应用主动脉尺寸及其相应的 Z 分数，结合手术和人口统计学因素。我们将再狭窄风险分类为低（≤10%）、中（11%至 29%）、中至高（30%至 49%）或高（≥50%）。峡部为 3.3 毫米或更小（1 年和 5 年无事件生存率分别为 38%和 32%）或峡部 Z 分数为-2.8 或更小且手术时体重小于 4.4 公斤（1 年和 5 年无事件生存率分别为 21%和 16%）的患者再狭窄风险最高。相反，低风险患者的峡部大于 3.7 毫米，远端主动脉弓大于 3.5 毫米（1 年和 5 年无事件生存率分别为 97%和 97%），峡部和近端主动脉弓 Z 分数大于-2.8 或手术时体重大于 4.4 公斤，峡部 Z 分数为-2.8 或更小（1 年和 5 年无事件生存率分别为 97%和 97%）。
再狭窄的风险可以根据术后出院前的超声心动图变量结合手术和人口统计学因素来预测。我们建议根据预测的再狭窄风险个体化调整随访间隔。
