title: Balloon angioplasty of recoarctation of the neoaortic arch after the Norwood operation: factors affecting outcome and recurrence.
abstract: BACKGROUND
  Balloon angioplasty (BA) is effective in relieving neoaorta recoarctation (reCoa) after the Norwood procedure. However, recurrence is not uncommon and risk factors for success and recurrence require further elucidation. We report the results of BA for reCoa following the Norwood procedure. We examine acute results and risk factors associated with success and recurrence after BA.
  
  
  METHODS
  Patients who underwent BA between November 2000 and June 2010 were studied. Factors for immediate success and recurrence after BA were determined using logistic regression. Recurrence-free survival was evaluated using the Kaplan-Meier curve.
  
  
  RESULTS
  Forty-seven angioplasties were performed in 39 patients. Mean age at catheterization was 5.0 ± 4.1 months. BA was successful in 40 angioplasties (85.1%). A higher preprocedure gradient across the coarctation (P = 0.04) and a higher ratio of balloon to descending aorta (P = 0.01) were associated with success. Six patients required redilation. Risk factors for recurrence included older age at Norwood (P = 0.02), younger age (P = 0.03), lower weight (P = 0.04) and smaller body surface area at balloon angioplasty (BA) (P = 0.04), and shorter duration between surgery and angioplasty (P = 0.03). Freedom from recurrence from the first catheterization was 82% after 6 months and 78% after 1 year. There were no neurologic sequelae or deaths.
  
  
  CONCLUSIONS
  BA is effective acutely and long term with limited morbidity and mortality. Recurrence occurs usually within the first year. Delay in performing the initial angioplasty may be beneficial in reducing the risk of recurrence, but further study is needed.
authors.affiliation: Department of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. edgard.bendaly@childrens.com
authors.forename: Edgard A
authors.initials: EA
authors.lastname: Bendaly
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lane
authors.forename: John P
authors.initials: JP
authors.lastname: Breinholt
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects* / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome