Do high-risk infants have a poorer outcome from primary repair of coarctation? Analysis of 192 infants over 20 years.

Hdl Handle:
http://hdl.handle.net/10147/207385
Title:
Do high-risk infants have a poorer outcome from primary repair of coarctation? Analysis of 192 infants over 20 years.
Authors:
McGuinness, Jonathan G; Elhassan, Yahya; Lee, Sim Yee; Nolke, Lars; Oslizlok, Paul; Walsh, Kevin; Redmond, J Mark; Wood, Alfred E
Affiliation:
Department of Cardiothoracic Surgery, Our Lady's Childrens Hospital, Crumlin,, Dublin, Ireland.
Citation:
Ann Thorac Surg. 2010 Dec;90(6):2023-7.
Journal:
The Annals of thoracic surgery
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207385
DOI:
10.1016/j.athoracsur.2010.06.130
PubMed ID:
21095356
Abstract:
BACKGROUND: Balloon angioplasty for infant coarctation is associated with a high recurrence rate, making operative repair the gold standard for low-risk infants. Debate exists as to whether high-risk infants might be better served with primary angioplasty. We compared the outcome in high-risk versus low-risk infants over 20 years, in a center that always used surgical repair as the primary intervention. METHODS: Of 192 infants from 1986 to 2005, 56 were considered "high-risk," defined as requiring prostaglandin infusion together with either epinephrine infusion for 24 hours preoperatively, or ventilation and milrinone infusion for 24 hours preoperatively. All high-risk patients had a period of ventricular dysfunction prior to surgery, ranging from mild to severe. Outcomes were compared using Bonferroni comparison of means or the Fischer exact test as appropriate. RESULTS: Although the high-risk patients were smaller (3.3 +/- 0.1 vs 4.2 +/- 0.2 kg, p < 0.01), younger (18 +/- 4 vs 57 +/- 7 days, p < 0.01), and more often required a concomitant pulmonary artery band (25% vs 15%, p = 0.05), their cross-clamp times were the same as the low-risk patients (18.9 +/- 0.9 vs 18.0 +/- 0.4 minutes, p = 0.27) and there was no difference in postoperative morbidity (7% vs 3%, p = 0.11). However, there was a trend toward higher perioperative mortality (7% vs 2%, p = 0.07). When compared with the published studies of primary angioplasty in comparable high-risk infants, the mortality rate in our surgically treated high-risk group is much lower. Additionally, only 11% of our high-risk group required reintervention, with two-thirds treated successfully with a single angioplasty at 3.8 +/- 2.2 years later, far lower than recurrence rates with primary angioplasty. CONCLUSIONS: We propose that primary surgical repair of coarctation in infants who are high risk should be the primary treatment, with angioplasty reserved for recurrent coarctation.
Language:
eng
MeSH:
Aortic Coarctation/diagnosis/mortality/*surgery; Cardiac Surgical Procedures/*methods; Echocardiography, Doppler; Female; Follow-Up Studies; Hospital Mortality/trends; Humans; Infant; Infant, Newborn; Ireland/epidemiology; Male; Prognosis; Recurrence; Retrospective Studies; Risk Factors; Severity of Illness Index; Survival Rate/trends; Time Factors
ISSN:
1552-6259 (Electronic); 0003-4975 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMcGuinness, Jonathan Gen_GB
dc.contributor.authorElhassan, Yahyaen_GB
dc.contributor.authorLee, Sim Yeeen_GB
dc.contributor.authorNolke, Larsen_GB
dc.contributor.authorOslizlok, Paulen_GB
dc.contributor.authorWalsh, Kevinen_GB
dc.contributor.authorRedmond, J Marken_GB
dc.contributor.authorWood, Alfred Een_GB
dc.date.accessioned2012-02-01T10:23:39Z-
dc.date.available2012-02-01T10:23:39Z-
dc.date.issued2012-02-01T10:23:39Z-
dc.identifier.citationAnn Thorac Surg. 2010 Dec;90(6):2023-7.en_GB
dc.identifier.issn1552-6259 (Electronic)en_GB
dc.identifier.issn0003-4975 (Linking)en_GB
dc.identifier.pmid21095356en_GB
dc.identifier.doi10.1016/j.athoracsur.2010.06.130en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207385-
dc.description.abstractBACKGROUND: Balloon angioplasty for infant coarctation is associated with a high recurrence rate, making operative repair the gold standard for low-risk infants. Debate exists as to whether high-risk infants might be better served with primary angioplasty. We compared the outcome in high-risk versus low-risk infants over 20 years, in a center that always used surgical repair as the primary intervention. METHODS: Of 192 infants from 1986 to 2005, 56 were considered "high-risk," defined as requiring prostaglandin infusion together with either epinephrine infusion for 24 hours preoperatively, or ventilation and milrinone infusion for 24 hours preoperatively. All high-risk patients had a period of ventricular dysfunction prior to surgery, ranging from mild to severe. Outcomes were compared using Bonferroni comparison of means or the Fischer exact test as appropriate. RESULTS: Although the high-risk patients were smaller (3.3 +/- 0.1 vs 4.2 +/- 0.2 kg, p < 0.01), younger (18 +/- 4 vs 57 +/- 7 days, p < 0.01), and more often required a concomitant pulmonary artery band (25% vs 15%, p = 0.05), their cross-clamp times were the same as the low-risk patients (18.9 +/- 0.9 vs 18.0 +/- 0.4 minutes, p = 0.27) and there was no difference in postoperative morbidity (7% vs 3%, p = 0.11). However, there was a trend toward higher perioperative mortality (7% vs 2%, p = 0.07). When compared with the published studies of primary angioplasty in comparable high-risk infants, the mortality rate in our surgically treated high-risk group is much lower. Additionally, only 11% of our high-risk group required reintervention, with two-thirds treated successfully with a single angioplasty at 3.8 +/- 2.2 years later, far lower than recurrence rates with primary angioplasty. CONCLUSIONS: We propose that primary surgical repair of coarctation in infants who are high risk should be the primary treatment, with angioplasty reserved for recurrent coarctation.en_GB
dc.language.isoengen_GB
dc.subject.meshAortic Coarctation/diagnosis/mortality/*surgeryen_GB
dc.subject.meshCardiac Surgical Procedures/*methodsen_GB
dc.subject.meshEchocardiography, Doppleren_GB
dc.subject.meshFemaleen_GB
dc.subject.meshFollow-Up Studiesen_GB
dc.subject.meshHospital Mortality/trendsen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInfanten_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.meshIreland/epidemiologyen_GB
dc.subject.meshMaleen_GB
dc.subject.meshPrognosisen_GB
dc.subject.meshRecurrenceen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshRisk Factorsen_GB
dc.subject.meshSeverity of Illness Indexen_GB
dc.subject.meshSurvival Rate/trendsen_GB
dc.subject.meshTime Factorsen_GB
dc.titleDo high-risk infants have a poorer outcome from primary repair of coarctation? Analysis of 192 infants over 20 years.en_GB
dc.contributor.departmentDepartment of Cardiothoracic Surgery, Our Lady's Childrens Hospital, Crumlin,, Dublin, Ireland.en_GB
dc.identifier.journalThe Annals of thoracic surgeryen_GB
dc.description.provinceLeinster-

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