Factors affecting long-term risk of aortic arch recoarctation after the Norwood procedure.
BACKGROUND
The purpose of this study was to identify factors predicting risk of aortic arch recoarctation after the Norwood procedure.


METHODS
Patient records were reviewed retrospectively for consecutive patients who underwent the Norwood procedure from 1996 to 2005. Preoperative and intraoperative parameters were identified for analysis. Aortic arch recoarctation was defined by the need for catheter or surgical reintervention. Data were analyzed using survival analysis, with freedom from intervention as the outcome. Factors predicting need for reintervention were analyzed using Cox proportional hazards regression.


RESULTS
Thirty-five recoarctations were observed in 117 patients (30%). Freedom from aortic arch reintervention at six months, one, three, and five years were 72%, 63%, 56%, and 52%, respectively. The majority of arch reinterventions occurred in the first six months (63%), involving either surgical (43%) or catheter (57%) techniques. The use of bovine pericardium showed the greatest risk for potential recoarctation (hazard ratio = 1.81 [0.90-3.64], p = 0.09). Age, gender, weight, ascending aortic diameter, ventricular morphology, primary anatomic diagnosis, and coarctation shelf resection were not found to be predictors of recoarctation.


CONCLUSIONS
Most interventions for aortic arch recoarctation after the Norwood procedure occur within the first six months of life. The type of patch material used for arch reconstruction appears to influence, most strongly, the long-term risk of aortic arch recoarctation.
Ashcraft
Traci M
TM
Division of Cardiothoracic Surgery, The Heart Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Jones
Karen
K
Border
William L
WL
Eghtesady
Pirooz
P
Pearl
Jeffrey M
JM
Khoury
Phillip R
PR
Manning
Peter B
PB
D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014654:Vascular Patency