Surgical approach for aortic coarctation influences arterial compliance and blood pressure control.
BACKGROUND
Increased arterial stiffness is linked to hypertension in adults after surgical repair for coarctation of the aorta. We evaluated the influence of surgical approaches, namely, subclavian flap repair (SFR) and end-to-end anastomosis (EEA), on arterial stiffness, blood pressure, cardiac output, and cardiac baroreceptor function in a cohort of young children after coarctation repair to determine if the surgical approach influenced longer term blood pressure control.


METHODS
We measured pulse wave velocity in 21 children with a mean age of 5 years, after early (less than 6 months) coarctation repair (SFR, n = 11; EEA, n = 10), and compared these with 18 matched controls. Blood pressure was recorded on three occasions from the right arm. Cardiac output was recorded using a transthoracic bioimpedence technique. We measured spontaneous baroreceptor reflex sensitivity to evaluate whether increased arterial stiffness was associated with reduced aortic baroreflex sensitivity.


RESULTS
Right arm systolic blood pressure (108.3 + or - 3.5 mm Hg SFR versus 97.8 + or - 2.9 mm Hg EEA, p = 0.03) and pulse wave velocity (6.0 + or - 0.2 ms(-1) SFR versus 5.2 + or - 0.2 ms(-1) EEA, p = 0.02) were significantly greater in the SFR compared with EEA group. Blood pressure and pulse wave velocity were also higher in the SFR group compared with controls. These differences were not demonstrated when comparing the EEA group with controls. There was no difference in stroke volume, spontaneous baroreceptor reflex sensitivity, or heart rate or blood pressure variability between the groups.


CONCLUSIONS
Young children undergoing SFR have higher blood pressure and stiffer upper limb arteries compared with matched children undergoing EEA. Our data suggest that better longer-term cardiovascular outcome is to be expected with the EEA surgical approach.
Kenny
Damien
D
Bristol Congenital Heart Centre, Bristol Royal Hospital for Children, Bristol, United Kingdom.
Polson
Jaimie W
JW
Martin
Robin P
RP
Wilson
Dirk G
DG
Caputo
Massimo
M
Cockcroft
John R
JR
Paton
Julian F R
JF
Wolf
Andrew R
AR
D000714:Anastomosis, Surgical; D001017:Aortic Coarctation / Q000503:physiopathology / Q000601:surgery*; D001158:Arteries / Q000503:physiopathology; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003187:Compliance; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery; D013524:Surgical Flaps