title: Intervention for recoarctation in the single ventricle reconstruction trial: incidence, risk, and outcomes.
abstract: BACKGROUND
  Recoarctation after the Norwood procedure increases risk for mortality. The Single Ventricle Reconstruction (SVR) trial randomized subjects with a single right ventricle undergoing a Norwood procedure to a modified Blalock-Taussig shunt or a right ventricle-pulmonary artery shunt. We sought to determine the incidence of recoarctation, risk factors, and outcomes in the SVR trial.
  
  
  RESULTS
  Recoarctation was defined by intervention, either catheter based or surgical. Univariate analysis and multivariable Cox proportional hazard models were performed with adjustment for center. Of the 549 SVR subjects, 97 (18%) underwent 131 interventions (92 balloon aortoplasty, 39 surgical) for recoarctation at a median age of 4.9 months (range, 1.1-10.5 months). Intervention typically occurred at pre-stage II catheterization (n=71, 54%) or at stage II surgery (n=38, 29%). In multivariable analysis, recoarctation was associated with the shunt type in place at the end of the Norwood procedure (hazard ratio, 2.0 for right ventricle-pulmonary artery shunt versus modified Blalock-Taussig shunt; P=0.02), and Norwood discharge peak echo-Doppler arch gradient (hazard ratio, 1.07 per 1 mm Hg; P<0.01). Subjects with recoarctation demonstrated comorbidities at pre-stage II evaluation, including higher pulmonary arterial pressures (15.4±3.0 versus 14.5±3.5 mm Hg; P=0.05), higher pulmonary vascular resistance (2.6±1.6 versus 2.0±1.0 Wood units·m(2); P=0.04), and increased echocardiographic volumes (end-diastolic volume, 126±39 versus 112±33 mL/BSA(1.3), where BSA is body surface area; P=0.02). There was no difference in 12-month postrandomization transplantation-free survival between those with and without recoarctation (P=0.14).
  
  
  CONCLUSIONS
  Recoarctation is common after Norwood and contributes to pre-stage II comorbidities. Although with intervention there is no associated increase in 1-year transplantation/mortality, further evaluation is warranted to evaluate the effects of associated morbidities.
authors.affiliation: Clinical Research Institute, Duke University Medical Center, 2400 Pratt St., Durham, NC 27705, USA. Kevin.hill@duke.edu
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
authors.forename: John F
authors.initials: JF
authors.lastname: Rhodes
authors.forename: Ranjit
authors.initials: R
authors.lastname: Aiyagari
authors.forename: G Hamilton
authors.initials: GH
authors.lastname: Baker
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chai
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Fleming
authors.forename: J Curt
authors.initials: JC
authors.lastname: Fudge
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gillespie
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gray
authors.forename: Russel
authors.initials: R
authors.lastname: Hirsch
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Pelech
authors.forename: Wolfgang A K
authors.initials: WA
authors.lastname: Radtke
authors.forename: Cheryl M
authors.initials: CM
authors.lastname: Takao
authors.forename: Julie A
authors.initials: JA
authors.lastname: Vincent
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
mesh_terms: D001017:Aortic Coarctation / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D058366:Blalock-Taussig Procedure / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D015999:Multivariate Analysis; D058327:Norwood Procedures / Q000379:methods*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: angioplasty; aortic coarctation; heart defects, congenital