Intervention for Recoarctation in the Single Ventricle Reconstruction Trial: Incidence, Risk, and Outcomes

BACKGROUND—Recoarctation after the Norwood procedure increases risk for mortality. The Single Ventricle Reconstruction (SVR) trial randomized subjects with a single right ventricle undergoing a Norwood procedure to a modified Blalock-Taussig shunt or a right ventricle–pulmonary artery shunt. We soug...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2013-08, Vol.128 (9), p.954-961
Main Authors: Hill, Kevin D., Rhodes, John F., Aiyagari, Ranjit, Baker, G. Hamilton, Bergersen, Lisa, Chai, Paul J., Fleming, Gregory A., Fudge, J. Curt, Gillespie, Matthew J., Gray, Robert G., Hirsch, Russel, Lee, Kyong-Jin, Li, Jennifer S., Ohye, Richard G., Oster, Matthew E., Pasquali, Sara K., Pelech, Andrew N., Radtke, Wolfgang A.K., Takao, Cheryl M., Vincent, Julie A., Hornik, Christoph P.
Format: Article
Language:English
Subjects:
Aortic Coarctation - epidemiology
Aortic Coarctation - mortality
Aortic Coarctation - surgery
Biological and medical sciences
Blalock-Taussig Procedure - methods
Blood and lymphatic vessels
Cardiology. Vascular system
Child
Child, Preschool
Cohort Studies
Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava
Diseases of the aorta
Diseases of the cardiovascular system
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Heart
Humans
Incidence
Infant
Medical sciences
Multivariate Analysis
Norwood Procedures - methods
Proportional Hazards Models
Prospective Studies
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Reoperation
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome
Citations: Items that this one cites
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Summary:BACKGROUND—Recoarctation after the Norwood procedure increases risk for mortality. The Single Ventricle Reconstruction (SVR) trial randomized subjects with a single right ventricle undergoing a Norwood procedure to a modified Blalock-Taussig shunt or a right ventricle–pulmonary artery shunt. We sought to determine the incidence of recoarctation, risk factors, and outcomes in the SVR trial. METHODS AND RESULTS—Recoarctation was defined by intervention, either catheter based or surgical. Univariate analysis and multivariable Cox proportional hazard models were performed with adjustment for center. Of the 549 SVR subjects, 97 (18%) underwent 131 interventions (92 balloon aortoplasty, 39 surgical) for recoarctation at a median age of 4.9 months (range, 1.1–10.5 months). Intervention typically occurred at pre–stage II catheterization (n=71, 54%) or at stage II surgery (n=38, 29%). In multivariable analysis, recoarctation was associated with the shunt type in place at the end of the Norwood procedure (hazard ratio, 2.0 for right ventricle–pulmonary artery shunt versus modified Blalock-Taussig shunt; P=0.02), and Norwood discharge peak echo-Doppler arch gradient (hazard ratio, 1.07 per 1 mm Hg; P
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.112.000488