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Experience of stent implantation for recurrent aortic arch obstruction following Norwood or Damus–Kaye–Stansel operation over the last decade

Published online by Cambridge University Press:  24 July 2019

Brian McCrossan ,
Lars Nolke ,
Damien Kenny ,
Paul Oslizlok ,
Gloria Crispino ,
Kevin P. Walsh  and
Colin J. McMahon
Brian McCrossan
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
Lars Nolke
Affiliation:
Department of Paediatric Cardiothoracic Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
Damien Kenny
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
Paul Oslizlok
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
Gloria Crispino
Affiliation:
National Clinical Research Centre, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland StatisticaMedica Ltd.Dublin 18, Ireland
Kevin P. Walsh
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
Colin J. McMahon*
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
*
Author for correspondence: Dr Colin J. McMahon, FAAP FACC FRCPI, Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland. Tel: 01 4096160; E-mail: [email protected]
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Abstract

Background:

Recurrent aortic arch obstruction following the Norwood procedure is recognised as an important complication. Balloon arch angioplasty is associated with a high recoarctation rate.

Methods:

We sought to evaluate the prevalence and outcome of stent implantation for recoarctation in children following Norwood or Damus–Kaye–Stansel procedure over the past decade at a single national cardiology centre.

Results:

Of 114 children who underwent Norwood procedure or Damus–Kaye–Stansel procedure between January 2003 and June 2013, 80 patients survived. Of these 15 children underwent stent implantation for recoarctation. Six of these patients had previous balloon angioplasty. The median age at stent implantation was 4.4 months (range 2–82 months). The median peak aortic arch gradient at catheterisation decreased from 26mmHg (range 10–70mmHg) to 2mmHg (range 0–20mmHg). The median luminal diameter increased from 4.7 mm (range 3.2–7.9 mm) to 8.6 mm (range 6.2–10.9 mm). The median coarctation index increased by 0.49 (range = 0.24–0.64). A Valeo stent was employed in 11 children, a Palmaz Genesis stent in 2 patients, a MultiLink stent in 1 child, and a Jomed covered stent in 1 child. Two factors were associated with the need for stent placement: previous arch angioplasty (p valve < 0.001, χ-square 11.5) and borderline left ventricle (p = 0.04, χ-square = 4.1). Stent migration occurred in one child. There were two deaths related to poor right ventricular systolic function and severe tricuspid regurgitation. Six patients underwent redilation of the stent with no complications.

Conclusions:

The prevalence of recurrent aortic arch obstruction following Norwood/Damus–Kaye–Stansel procedure was 18%. Stent implantation is safe and reliably eliminates the aortic obstruction. Redilation can be successfully achieved to accommodate somatic growth or development of stent recoarctation.

Keywords

Coarctationstenthypoplastic left heart syndromeNorwood operationDamus–Kaye–Stansel procedure
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 9 , September 2019 , pp. 1137 - 1142
Copyright
© Cambridge University Press 2019 

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References

Ashcraft, TM, Jones, K, Border, WL, et al. Factors affecting long-term risk of aortic arch recoarctation after the Norwood procedure. Ann Thorac Surg 2008; 85: 1397–1402.CrossRefGoogle ScholarPubMed
Bautista-Hernandez, V, Marx, GR, Gauvreau, K, et al. Coarctectomy reduces neoaortic arch obstruction in hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2007; 133: 1540–1546.CrossRefGoogle ScholarPubMed
Chessa, M, Dindar, A, Vettukattil, JJ, et al. Balloon angioplasty in infants with aortic obstruction after the modified stage I Norwood procedure. Am Heart J 2000; 140: 227–231.CrossRefGoogle ScholarPubMed
Soongswang, J. Outcomes of transcatheter balloon angioplasty of obstruction in the neo-aortic arch after the Norwood operation. Cardiol Young 2001; 11: 54–61.CrossRefGoogle ScholarPubMed
Tworetzky, W, McElhinney, DB, Burch, GH, Teitel, DF, Moore, P. Balloon arterioplasty of recurrent coarctation after the modified Norwood procedure in infants. Catheter Cardiovasc Interv 2000; 50: 54–58.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
Zeltser, I, Menteer, J, Gaynor, JW, et al. Impact of re-coarctation following the Norwood operation on survival in the balloon angioplasty era. J Am Coll Cardiol 2005; 45: 1844–1848.CrossRefGoogle ScholarPubMed
Larrazabal, LA, Tierney, ESS, Brown, DW, et al. Ventricular function deteriorates with recurrent coarctation in hypoplastic left heart syndrome. Ann Thorac Surg 2008; 86: 869–874.CrossRefGoogle ScholarPubMed
Fraisse, M, Colan, SD, Jonas, RA, Gauvreau, K, Geva, T. Accuracy of echocardiography for detection of aortic arch obstruction after stage I Norwood procedure. Am Heart J 1998; 135: 230–236.CrossRefGoogle ScholarPubMed
Jonas, RA. Intermediate procedures after first-stage Norwood operation facilitate subsequent repair. Ann Thorac Surg 1991; 52: 696–700.CrossRefGoogle ScholarPubMed
Hill, KD, Rhodes, JF, Aiyagari, R, et al. Intervention for recoarctation in the single ventricle reconstruction trial: incidence, risk, and outcomes. Circulation 2013; 128: 954–961.CrossRefGoogle Scholar
Porras, D, Brown, DW, Marshall, AC, Del Nido, P, Bacha, EA, McElhinney, DB. Factors associated with subsequent arch reintervention after initial balloon aortoplasty in patients with Norwood procedure and arch obstruction. J Am Coll Cardiol 2011; 58: 868–876.CrossRefGoogle ScholarPubMed
Aldoss, O, Patel, S, Divekar, A. Prograde transcatheter aortic arch intervention in patients with single-ventricle physiology: a word of caution. Congenital Heart Dis 2014; 10: 64–68.CrossRefGoogle ScholarPubMed
Ewert, P, Peters, B, Nagdyman, N, Miera, O, Kühne, T, Berger, F. Early and mid-term results with the growth stent—a possible concept for transcatheter treatment of aortic coarctation from infancy to adulthood by stent implantation? Catheter Cardiovasc Interv 2008; 71: 120–126.CrossRefGoogle ScholarPubMed
Tomita, H, Kimura, K, Kurosaki, K, et al. Stent implantation for aortic coarctation complicating the Norwood operation in a 48-day-old baby. Catheter Cardiovasc Interv 2001; 54: 239–241.CrossRefGoogle Scholar
Kutty, S, Burke, RP, Hannan, RL, Zahn, EM. Hybrid aortic reconstruction for treatment of recurrent aortic obstruction after stage 1 single ventricle palliation: medium term outcomes and results of redilation. Catheter Cardiovasc Interv 2011; 78: 93–100.CrossRefGoogle ScholarPubMed
Schaeffler, R, Sarikouch, S, Peuster, M. Anterograde stent implantation for treatment of recurrent coarctation after Norwood operation. Pediatr Cardiol 2008; 29: 388–392.CrossRefGoogle ScholarPubMed
Hijazi, ZM, Geggel, RL. Balloon angioplasty for postoperative recurrent coarctation of the aorta. J Interv Cardiol 1995; 8: 509–516.CrossRefGoogle ScholarPubMed
Martin, BJ, Maruyama, M, Rebeyka, IM. Repair of recoarctation after the Norwood operation: the right-sided posterior approach. J Thorac Cardiovasc Surg 2016; 152: 1622–1624.CrossRefGoogle ScholarPubMed
Sakuri, T, Rogers, V, Stickley, J, Khan, N, Jones, TJ, Brawn, WJ. Single-center experience of arch reconstruction in the setting of Norwood operation. Ann Thorac Surg 2012; 94: 1534–9.CrossRefGoogle Scholar
Forbes, TJ, Kim, DW, Du, W, et al. Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (Congenital cardiovascular interventional study consortium). J Am Coll Cardiol 2011; 58: 2664–2674.CrossRefGoogle Scholar
Rothman, A, Perry, SB, Keane, JF, Lock, JE. Early results and follow-up of balloon angioplasty for branch pulmonary artery stenoses. J Am Coll Cardiol 1990; 15: 1109–1117.CrossRefGoogle ScholarPubMed
Butera, GM, Giugno, L, Basile, L, Piazza, D, Chessa, L, Carminati, M. The Edwards Valeo lifestents in the treatment and palliation of congenital heart disease in infants and small children. Catheter Cardiovasc Interv 2015; 86: 432–437. CrossRefGoogle ScholarPubMed
Ing, FF. Delivery of stents to target lesions: techniques of intraoperative stent implantation and intraoperative angiograms. Pediatr Cardiol 2005; 26: 260–266.CrossRefGoogle ScholarPubMed
Travelli, FFA, Sullivan, FC, Takao, PM, Ing, F. The Valeo stent: a pre-mounted, open-cell, large stent for use in small children with CHD. Cardiol Young 2016; 26: 1187–1193.CrossRefGoogle ScholarPubMed
Ovaert, C, Luciano, D, Gaudart, J, et al. The VALEO vascular stent for cardiovascular lesions in children. EuroIntervention 2015; 10: 1326–1331.CrossRefGoogle ScholarPubMed
Sathanandam, SK, Haddad, LM, Subramanian, S, Wright, D, Philip, R, Waller, BR. Unzipping of small diameter stents: an in vitro study. Catheter Cardiovasc Interv 2015; 85: 249–258.CrossRefGoogle ScholarPubMed
Thanopoulos, BD, Giannakoulas, G, Giannopoulos, A, Galdo, F, Tsaoussis, GS. Initial and six-year results of stent implantation for aortic coarctation in children. Am J Cardiol 2012; 109: 1499–1503.CrossRefGoogle ScholarPubMed
Schaeffler, R, Kolax, T, Hesse, C, Peuster, M. Implantation of stents for treatment of recurrent and native coarctation in children weighing less than 20 kilograms. Cardiol Young 2007; 17: 617–622.CrossRefGoogle ScholarPubMed