Intervention for arch obstruction after the Norwood procedure: Prevalence,associated factors,and practice variability |
| |
| Authors: | Paul J Devlin Brian W McCrindle James K Kirklin Eugene H Blackstone William M DeCampli Christopher A Caldarone Ali Dodge-Khatami Pirooz Eghtesady James M Meza Peter J Gruber Kristine J Guleserian Bahaaladin Alsoufi Linda M Lambert James E O&#x;Brien Erle H Austin Jeffrey P Jacobs Tara Karamlou |
| |
| Affiliation: | 1. Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada;2. Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada;3. Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala;4. Division of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio;5. Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla;6. Department of Cardiovascular Surgery, Baylor College of Medicine, Houston, Tex;7. Division of Pediatric Cardiac Surgery, The University of Mississippi Medical Center, Jackson, Miss;8. Department of Pediatric Cardiothoracic Surgery, Washington University Medical School, St Louis, Mo;9. Department of Surgery, Duke University Medical Center, Durham, NC;10. Department of Surgery, Yale University School of Medicine, New Haven, Conn;11. Division of Cardiovascular Surgery, Nicklaus Children''s Hospital, Miami, Fla;12. Cardiovascular Surgery, Norton Children''s Hospital, University of Louisville, Louisville, Ky;13. Department of Pediatrics, Primary Children''s Hospital, Salt Lake City, Utah;14. The Ward Family Heart Center, Children''s Mercy Hospitals and Clinics, Kansas City, Mo;15. Division of Cardiovascular Surgery, Johns Hopkins All Children''s Hospital, St Petersburg, Fla;p. Division of Pediatric Cardiac Surgery, Rady Children''s Hospital, San Diego, Calif |
| |
| Abstract: | ObjectiveArch obstruction after the Norwood procedure is common and contributes to mortality. We determined the prevalence, associated factors, and practice variability of arch reintervention and assessed whether arch reintervention is associated with mortality.MethodsFrom 2005 to 2017, 593 neonates in the Congenital Heart Surgeons' Society Critical Left Heart Obstruction cohort underwent a Norwood procedure. Median follow-up was 3.7 years. Multivariable parametric models, including a modulated renewal analysis, were performed.ResultsOf the 593 neonates, 146 (25%) underwent 218 reinterventions for arch obstruction after the Norwood procedure: catheter-based (n = 168) or surgical (n = 50) at a median age of 4.3 months (quartile 1-quartile 3, 2.6-5.7). Interdigitation of the distal aortic anastomosis was protective against arch reintervention. Development of ≥ moderate tricuspid valve regurgitation and right ventricular dysfunction at any point was associated with arch reintervention. Nonsignificant variables for arch reintervention included shunt type and preoperative aortic measurements. Surgical arch reintervention was protective against arch reintervention, but transcatheter reintervention was associated with increased reintervention. Arch reintervention was not associated with increased mortality. There was wide institutional variation in incidence of arch reintervention (range, 0-40 reinterventions per 100 years patient follow-up) and in preintervention gradient (range, 0-64 mm Hg).ConclusionsInterdigitation of the distal aortic anastomosis during the Norwood procedure decreased the risk of arch reintervention. Surgical arch reintervention is more definitive than transcatheter. Arch reintervention after the Norwood procedure is not associated with increased mortality. Serial surveillance for arch obstruction, integrated with changes in right ventricular function and tricuspid valve regurgitation, is recommended after the Norwood procedure to improve outcomes. |
| |
| Keywords: | Norwood neoaorta arch obstruction coarctation interdigitation hypoplastic left heart syndrome critical left heart obstruction CHSS Congenital Heart Surgeons' Society SVR Single Ventricle Reconstruction |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
