Turaev Bobur, Abralov Khakimjon, Ibragimov Nodir
Tashkent Pediatric Medical Institute Hospital, Tashkent, Uzbekistan.
The Republican Specialized Scientific and Practical Medical Center for Surgery named after Academician V. Vakhidov, Tashkent, Uzbekistan.
Kardiochir Torakochirurgia Pol. 2024 Dec;21(4):211-217. doi: 10.5114/kitp.2024.145904. Epub 2024 Dec 13.
Coarctation of the aorta (CoA) patients often experience recoarctation, the reoccurrence of aortic narrowing, presenting a considerable clinical challenge.
This study aims to investigate the triggers or contributing factors associated with the development of recoarctation (reCoA) following the initial repair of CoA.
The retrospective cohort study includes information about 120 patients, who underwent 4 different types of surgical repairs of coarctation of the aorta through left thoracotomy in the period 2012-2022. Recoarctation was evaluated using the pressure gradient on the coarctation site measured by echocardiography (echoCG). A threshold of more than 20 mm Hg was employed to define recoarctation. All statistical analysis was performed using SPSS and Jamovi applications.
The study revealed that 30 (25%) patients experienced early recoarctation, while 52 (43.7%) patients encountered late recoarctation. Among the 28 (23.3%) patients who had arch hypoplasia, 12 experienced early recoarctation, and 22 exhibited late recoarctation. Correlation tests demonstrated a strong negative correlation of the z-score of the arch size with both early recoarctation ( = -0.229, = 0.013) and late recoarctation ( = -0.421, < 0.001). Resection and end-to-end anastomosis (EEA) displayed the highest proportions of early (59%) and late (77%) recoarctation.
Aortic arch hypoplasia emerges as a significant risk factor for both early and late recoarctation. Additionally, while all coarctation repair methods carry some risk of recoarctation, resection and end-to-end anastomosis and prosthetic patch aortoplasty may pose a higher risk compared to extended end-to-end anastomosis.
主动脉缩窄（CoA）患者常出现再缩窄，即主动脉狭窄复发，这带来了相当大的临床挑战。
本研究旨在调查CoA初次修复后再缩窄（reCoA）发生的触发因素或相关因素。
这项回顾性队列研究纳入了120例患者的信息，这些患者在2012年至2022年期间通过左胸切口接受了4种不同类型的主动脉缩窄手术修复。使用超声心动图（echoCG）测量缩窄部位的压力梯度来评估再缩窄。采用超过20 mmHg的阈值来定义再缩窄。所有统计分析均使用SPSS和Jamovi应用程序进行。
研究显示，30例（25%）患者出现早期再缩窄，52例（43.7%）患者出现晚期再缩窄。在28例（23.3%）存在主动脉弓发育不全的患者中，12例出现早期再缩窄，22例出现晚期再缩窄。相关性测试表明，主动脉弓大小的z评分与早期再缩窄（r = -0.229，p = 0.013）和晚期再缩窄（r = -0.421，p < 0.001）均呈强负相关。切除及端端吻合术（EEA）出现早期（59%）和晚期（77%）再缩窄的比例最高。
主动脉弓发育不全是早期和晚期再缩窄的重要危险因素。此外，虽然所有缩窄修复方法都有一定的再缩窄风险，但与扩大端端吻合术相比，切除及端端吻合术和人工补片主动脉成形术可能具有更高的风险。
