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Intervention for recoarctation in the single ventricle reconstruction trial: incidence, risk, and outcomes.

Publication ,  Journal Article
Hill, KD; Rhodes, JF; Aiyagari, R; Baker, GH; Bergersen, L; Chai, PJ; Fleming, GA; Fudge, JC; Gillespie, MJ; Gray, RG; Hirsch, R; Lee, K-J ...
Published in: Circulation
August 27, 2013

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<0.01). Subjects with recoarctation demonstrated comorbidities at pre-stage II evaluation, including higher pulmonary arterial pressures (15.4±3.0 versus 14.5±3.5 mm Hg; P=0.05), higher pulmonary vascular resistance (2.6±1.6 versus 2.0±1.0 Wood units·m(2); P=0.04), and increased echocardiographic volumes (end-diastolic volume, 126±39 versus 112±33 mL/BSA(1.3), where BSA is body surface area; P=0.02). There was no difference in 12-month postrandomization transplantation-free survival between those with and without recoarctation (P=0.14). CONCLUSIONS: Recoarctation is common after Norwood and contributes to pre-stage II comorbidities. Although with intervention there is no associated increase in 1-year transplantation/mortality, further evaluation is warranted to evaluate the effects of associated morbidities.

Duke Scholars

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 27, 2013

Volume

128

Issue

9

Start / End Page

954 / 961

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Prospective Studies
  • Proportional Hazards Models
  • Norwood Procedures
  • Multivariate Analysis
  • Infant
 

Citation

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ICMJE
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Hill, K. D., Rhodes, J. F., Aiyagari, R., Baker, G. H., Bergersen, L., Chai, P. J., … Hornik, C. P. (2013). Intervention for recoarctation in the single ventricle reconstruction trial: incidence, risk, and outcomes. Circulation, 128(9), 954–961. https://doi.org/10.1161/CIRCULATIONAHA.112.000488
Hill, Kevin D., John F. Rhodes, Ranjit Aiyagari, G Hamilton Baker, Lisa Bergersen, Paul J. Chai, Gregory A. Fleming, et al. “Intervention for recoarctation in the single ventricle reconstruction trial: incidence, risk, and outcomes.Circulation 128, no. 9 (August 27, 2013): 954–61. https://doi.org/10.1161/CIRCULATIONAHA.112.000488.
Hill KD, Rhodes JF, Aiyagari R, Baker GH, Bergersen L, Chai PJ, et al. Intervention for recoarctation in the single ventricle reconstruction trial: incidence, risk, and outcomes. Circulation. 2013 Aug 27;128(9):954–61.
Hill, Kevin D., et al. “Intervention for recoarctation in the single ventricle reconstruction trial: incidence, risk, and outcomes.Circulation, vol. 128, no. 9, Aug. 2013, pp. 954–61. Pubmed, doi:10.1161/CIRCULATIONAHA.112.000488.
Hill KD, Rhodes JF, Aiyagari R, Baker GH, Bergersen L, Chai PJ, Fleming GA, Fudge JC, Gillespie MJ, Gray RG, Hirsch R, Lee K-J, Li JS, Ohye RG, Oster ME, Pasquali SK, Pelech AN, Radtke WAK, Takao CM, Vincent JA, Hornik CP. Intervention for recoarctation in the single ventricle reconstruction trial: incidence, risk, and outcomes. Circulation. 2013 Aug 27;128(9):954–961.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 27, 2013

Volume

128

Issue

9

Start / End Page

954 / 961

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Prospective Studies
  • Proportional Hazards Models
  • Norwood Procedures
  • Multivariate Analysis
  • Infant