Risk Factors for Increased Post-operative Length of Stay in Children with Coarctation of Aorta

Schoeneberg, Laura; Prodhan, Parthak; Spray, Beverly J.; Akmyradov, Chary; Zakaria, Dala

doi:10.1007/s00246-021-02641-x

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…According to a study conducted with the data of coarctation patients treated in 52 hospitals in the United States, the presence of prematurity and low birth weight may lead to both prolonged hospitalization and increased in-hospital mortality. In addition, each 30-day delay in hospitalization of the patient reduces the postoperative hospital stay of the patient by 2.6 days 8 . IJsselhof et al, compared neonate and infant patients who underwent coarctation repair and found that neonate patients have required significantly longer intensive care and total hospitalization, compared with infants.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of the effectiveness of coarctation surgery between neonates and infants

Yilmaz,

Turkcan,

Ecevit

et al. 2024

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: This study aimed to compare the effectiveness of resection and extended end-to-end anastomosis between neonate and infant patients with coarctation. METHODS: This study was designed retrospectively and included 41 neonate (<30 days) and infant (30 days to 1 year) patients who were operated on using the resection and extended end-to-end anastomosis technique for aortic coarctation. Preoperative aortic annulus diameters and Z scores, all aortic arch diameters and Z scores, the presence of hypoplastic aortic segment, and the presence of prematurity were reviewed in both groups. Subsequently, we investigated whether these parameters were statistically related to the residual gradient in the operation area, whether there was a need for early re-intervention, and what was the incidence of mortality in the early postoperative period. In addition, the aortic arch Z scores of the patients at 6 months postoperatively were examined. RESULTS: While the mean age (p<0.001), body weight (p<0.001), and proximal arch Z score (p=0.029) were found to be significantly lower in the neonate group than in the infant group, the total length of the intensive care unit stay (p=0.013) and the total length of hospital stay (p=0.017) were found to be significantly higher. In addition, significant enlargement was detected in the proximal arch, distal arch, and isthmus segments in both patient groups. CONCLUSION: The resection and extended end-to-end anastomosis is an equally effective technique that can provide a marked decrease in gradient in the coarctation area and a significant enlargement of the aortic arch segments in the early period after coarctation repair in both neonate and infant patients.

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Section: Discussionmentioning

confidence: 99%

Comparative analysis of the effectiveness of coarctation surgery between neonates and infants

Yilmaz,

Turkcan,

Ecevit

et al. 2024

Rev. Assoc. Med. Bras.

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“…Coarctation of the aorta can be accompanied by associated transverse arch hypoplasia. Signi cant disease requires repair in the neonatal period or early infancy to ensure optimal long-term outcomes [2].…”

Section: Introductionmentioning

confidence: 99%

“…Non-invasive imaging modalities have been used to diagnose and manage coarctation in neonates and infants including echocardiography, cardiac computed tomography angiography (CTA), and cardiac magnetic resonance imaging (cMRI) [3].While echocardiography is the most frequently used imaging modality in the diagnosis and management of coarctation, its limitations include de ning complex aortic arch anatomy [4]. CTA has been increasingly used for the evaluation of arch hypoplasia and associated arch anomalies in coarctation [2][3][4][5][6][7]. Indications for CTA include question of coarctation severity, transverse arch hypoplasia, or atypical or syndromic coarctation [8].…”

Section: Introductionmentioning

confidence: 99%

Pre-operative Imaging of Critical Coarctation of the Aorta: Impact on Surgical Approach and Outcomes

McVadon,

Zyblewski,

Chowdhury

2023

Pediatr Cardiol

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Background: Computed tomographic angiography (CTA) has been increasingly used for the evaluation of infants with aortic arch hypoplasia and coarctation of the aorta. The goals of this study were to compare echocardiographic and CTA ndings in critical coarctation of the aorta, to evaluate each modality's in uence on surgical approach for repair and determine if pre-operative measurements or surgical approach are associated with residual lesions/re-interventions.Methods: This was a single center retrospective cohort study that included 85 neonates and infants who underwent repair of coarctation/arch hypoplasia by three months of age. Two groups were compared: patients with preoperative echocardiograms only and patients with both echocardiogram and CTA evaluations.Results: 44 (52%) patients received an echocardiogram and CTA, and 41 (48%) patients received an echocardiogram only. Patients in the CTA + echo group had smaller mitral valve and ascending aorta measurements (p = 0.01). When comparing CTA to echocardiogram measurements, the aortic valve annulus, ascending aorta, proximal and distal transverse arch, and isthmus were smaller on echo (p < 0.01). A smaller aortic valve annulus and aortic root as well as thoracotomy approach were associated with residual gradients/re-intervention (p<0.01).Conclusions: Our study found that patients who underwent CTA pre-operatively had smaller left sided structures. Aortic measurements were smaller on echocardiogram when compared to CTA. Smaller left sided structures proximal to the aortic arch and thoracotomy predicted the development of residual lesions/re-intervention. CTA is useful in the surgical planning for neonates with arch hypoplasia/coarctation and may help risk stratify for residual lesions/re-intervention. P-values represent results of a one sample t-test to determine if the mean difference between the CTA and echo measurements were statistically signi cantly different from zero

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“…Kumar et al showed that the early blood pressure gradient after aortic surgery was a significant predictor of recoarctation in the long term ( 6 ). Schoeneberg's study on the influencing factors of postoperative hospital stay in children with CoA showed that preterm birth (before 37 weeks of gestation) was an independent risk factor for postoperative hospital stay and postoperative mortality ( 7 ). However, a literature search found few relevant studies on the degree of aortic coarctation on early prognosis after surgical correction in infants.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography angiography assessment of the degree of simple coarctation of the aorta and its relationship with surgical outcome: A retrospective analysis

et al. 2022

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ObjectiveTo investigate the correlation between the degree of aortic coarctation and surgical prognosis in infants with simple coarctation of the aorta (CoA) using computed tomography angiography (CTA).MethodsThis study was a retrospective study. Twenty-seven infants with simple CoA who underwent surgical correction from January 2020 to June 2022 were enrolled. Aortic diameters were measured at five different levels and normalized to Z scores based on the square root of body surface area. The relevant data were collected and analyzed, and the predictors associated with surgical outcome were determined.ResultsPatients were divided into the mild CoA group and the severe CoA group according to the severity of coarctation. The mechanical ventilation duration and the length of ICU stay in the mild CoA group were significantly lower than those in the severe CoA group. Multiple linear regression analyses revealed that the degree of aortic coarctation was a significant risk factor for a prolonged postoperative ICU stay. In addition, gestational age and age at operation were risk factors for a prolonged postoperative ICU stay. Correlation analysis showed that the degree of aortic coarctation correlated with the Z scores of the ascending aorta and postcoarctation aorta.ConclusionThe degree of the CoA is an important predictor of surgical outcomes in infants with simple CoA and was significantly correlated with the ascending aorta and postcoarctation aorta Z scores. Therefore, preoperative CTA should be routinely performed to assess the degree of aortic coarctation and better identify risk factors.

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Risk Factors for Increased Post-operative Length of Stay in Children with Coarctation of Aorta

Cited by 6 publications

References 29 publications

Comparative analysis of the effectiveness of coarctation surgery between neonates and infants

Comparative analysis of the effectiveness of coarctation surgery between neonates and infants

Pre-operative Imaging of Critical Coarctation of the Aorta: Impact on Surgical Approach and Outcomes

Computed tomography angiography assessment of the degree of simple coarctation of the aorta and its relationship with surgical outcome: A retrospective analysis

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