Reintervention for arch obstruction after stage 1 reconstruction does not adversely affect survival or outcome at Fontan completion.
OBJECTIVE
To determine the effect of reintervention for coarctation after stage 1 reconstruction for hypoplastic left heart syndrome and variants on survival, suitability for Fontan, and morbidity at Fontan.


METHODS
A retrospective review of echocardiograms, catheterizations, hospital records of patients who underwent stage 1 reconstruction from January 2002 to May 2005, with a cross-sectional analysis of hospital survivors, was performed. Kaplan-Meier curves were derived for patients alive more than 30 days after stage 1 reconstruction.


RESULTS
A total of 176 patients underwent stage 1 reconstruction. Forty-three patients (23%) underwent balloon angioplasty (n = 43) or surgical intervention (n = 4) for re-coarctation. Median time to intervention was 123 (1-316) days. Seven of 43 patients (16%) underwent more than 1 balloon angioplasty. Thirty-nine patients underwent intervention before stage 2 reconstruction, and 4 patients had intervention between stage 2 reconstruction and Fontan. Kaplan-Meier curves showed no difference in freedom from death or transplant between patients who did and did not undergo intervention for re-coarctation. Fontan completion was performed in 107 patients. By echocardiogram, the prevalence of moderate to severe ventricular dysfunction between groups was similar at Fontan; however, significant atrioventricular valve regurgitation was more common in patients who required intervention (28/33 vs 40/65, P = .02). Overall Fontan mortality was 2% and not different between groups. Length of stay was not different between patients with and without re-coarctation.


CONCLUSIONS
Reintervention for coarctation after stage 1 reconstruction is common. Hemodynamic differences between groups did not affect Fontan completion, mortality, or hospital length of stay. Follow-up is necessary to determine the impact of re-coarctation on longer-term mortality and morbidity.
Ballweg
Jean A
JA
Children's Hospital of Philadelphia, PA, USA. jballweg@uthsc.edu
Dominguez
Troy E
TE
Tabbutt
Sarah
S
Rome
Jonathan J
JJ
Gaynor
J William
JW
Nicolson
Susan C
SC
Spray
Thomas L
TL
Ravishankar
Chitra
C
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000401:mortality; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization; D003430:Cross-Sectional Studies; D004452:Echocardiography; D018729:Fontan Procedure / Q000009:adverse effects / Q000401:mortality; D006349:Heart Valve Diseases / Q000209:etiology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D015143:Philadelphia; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D018754:Ventricular Dysfunction / Q000209:etiology / Q000601:surgery