Dijkema E J, Dik L, Breur J M P, Sieswerda G T, Haas F, Slieker M G, Schoof P H
Department of Pediatric Cardiology, Wilhelmina Children's Hospital (WKZ), University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Neth Heart J. 2021 Feb;29(2):98-104. doi: 10.1007/s12471-020-01513-y. Epub 2020 Nov 11.
This study focuses on the evolution of treatment techniques for aortic coarctation in children and assesses long-term morbidity.
This retrospective cohort study evaluates patients treated for native aortic coarctation, with at least 7 years of follow-up. To assess time-related changes, three time periods were distinguished according to year of primary intervention (era 1, 2 and 3). Operative and long-term follow-up data were collected by patient record reviews.
The study population consisted of 206 patients (177 surgical and 29 catheter-based interventions), with a median follow-up of 151 months. Anterior approach with simultaneous repair of aortic arch and associated cardiac lesions was more common in the most recent era. Median age at intervention did not change over time. Reintervention was necessary in one third of the cohort with an event-free survival of 74% at 5‑year and 68% at 10-year follow-up. Reintervention rates were significantly higher after catheter-based interventions compared with surgical interventions (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.04-3.00, p = 0.04) and in patients treated before 3 months of age (HR 2.1, 95% CI 1.27-3.55, p = 0.003). Hypertension was present in one out of five patients.
Nowadays, complex patients with associated cardiac defects and arch hypoplasia are being treated surgically on bypass, whereas catheter-based intervention is introduced for non-complex patients. Reintervention is common and more frequent after catheter-based intervention and in surgery under 3 months of age. One fifth of the 206 patients remained hypertensive.
本研究聚焦于儿童主动脉缩窄治疗技术的演变，并评估长期发病率。
这项回顾性队列研究评估了接受原发性主动脉缩窄治疗且随访至少7年的患者。为评估与时间相关的变化，根据首次干预年份将其分为三个时间段（时期1、2和3）。通过查阅患者病历收集手术及长期随访数据。
研究人群包括206例患者（177例接受手术治疗，29例接受导管介入治疗），中位随访时间为151个月。在最近时期，采用前路手术同时修复主动脉弓及相关心脏病变更为常见。干预时的中位年龄未随时间变化。三分之一的队列患者需要再次干预，5年无事件生存率为74%，10年为68%。与手术干预相比，导管介入治疗后的再次干预率显著更高（风险比[HR]1.8，95%置信区间[CI]1.04 - 3.00，p = 0.04），且3个月龄前接受治疗的患者再次干预率更高（HR 2.1，95%CI 1.27 - 3.55，p = 0.003）。五分之一的患者存在高血压。
如今，合并心脏缺陷和主动脉弓发育不全的复杂患者在体外循环下接受手术治疗，而对于非复杂患者则采用导管介入治疗。再次干预很常见，在导管介入治疗后以及3个月龄以下手术的患者中更为频繁。206例患者中有五分之一仍患有高血压。
