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Is the medical treatment for arterial hypertension after primary aortic coarctation repair related to age at surgery? A retrospective cohort study

Published online by Cambridge University Press:  09 June 2017

Peter J Lillitos ,
Mohamed S. Nassar ,
Shane M Tibby ,
Joy Simmonds ,
Caner Salih ,
Conal Austin ,
David Anderson  and
Thomas Krasemann
Peter J Lillitos*
Affiliation:
Department of Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, United Kingdom
Mohamed S. Nassar
Affiliation:
Department of Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, United Kingdom Department of Cardiothoracic Surgery, Alexandria University, Alexandria, Egypt
Shane M Tibby
Affiliation:
Department of Paediatric Intensive Care, Evelina London Children’s Hospital, London, United Kingdom
Joy Simmonds
Affiliation:
Department of Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, United Kingdom
Caner Salih
Affiliation:
Department of Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, United Kingdom
Conal Austin
Affiliation:
Department of Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, United Kingdom
David Anderson
Affiliation:
Department of Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, United Kingdom
Thomas Krasemann
Affiliation:
Department of Cardiology and Cardiac Surgery, Evelina London Children’s Hospital, London, United Kingdom Department of Pediatric Cardiology, Sophia Kinderziekenhuis, Erasmus Medical Centre, Rotterdam, The Netherlands King’s College London, London, United Kingdom
*
Corresponding to: P. J. Lillitos, Department of Paediatric Cardiology, Evelina London Children’s Hospital, St Thomas’s Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom. Tel: +0 044 776 967 5601; E-mail: plillitos@doctors.org.uk
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Abstract

Background

Hypertension following primary coarctation repair affects up to a third of subjects. A number of studies suggest that future hypertension risk is reduced if primary repair is performed at a younger age.

Objectives

The objective of this study was to evaluate the risk of future medical treatment for hypertension depending on age of primary coarctation repair.

Methods

This study was carried out at a tertiary paediatric cardiology referral centre. Retrospective database evaluation of children aged <16 years undergoing primary surgical coarctation repair between October, 2005 and October, 2014 was carried out. Patients with complex heart diseases were excluded. The following age groups were considered: neonate (⩽28 days), infant (>28 days and ⩽12 months), and children (>12 months). Main outcome measure is the need for long-term anti-hypertensive medication. The risk for re-coarctation was also evaluated.

Results

A total of 87 patients were analysed: 60 neonates, 17 infants, 10 children. Among them, 6.7% neonates, 29.4% infants, and 40% children required long-term anti-hypertensive medications. Group differences were statistically significant (p=0.004). After adjustment for type of repair, the risk of long-term anti-hypertensive therapy was 4.5 (95% confidence interval 1.2–16.9, p=0.025) and 10.5 times (95% confidence interval 2.6–42.3, p=0.001) higher if primary repair was carried out in infancy and childhood, respectively, compared with neonates. Among all, 13 patients developed re-coarctation: 21.7% in the neonatal group, 5.9% in the infant group, and 20% in the child group. We could not demonstrate a significant difference between these proportions or calculate a reliable risk for developing re-coarctation.

Conclusions

Risk of medical treatment for hypertension was lowest when primary repair was carried out during the neonatal period, rising 10-fold if first operated on as a child. Knowing the likelihood of hypertension development depending on age of primary repair is useful for long-term surveillance and counselling.

Keywords

Coarctationageoperationhypertension
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1701 - 1707
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Copyright
© Cambridge University Press 2017 

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References

1. Padua, LM, Garcia, LC, Rubira, CJ, et al. Stent placement versus surgery for coarctation of the thoracic aorta. Cochrane Database of Syst Rev 2012; 5: CD008204.Google Scholar
2. Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e143–e263.CrossRefGoogle Scholar
3. Canniffe, C, Ou, P, Walsh, K, et al. Hypertension after repair of aortic coarctation--a systematic review. Int J Cardiol 2013; 167: 2456–2461.Google Scholar
4. Brown, ML, Burkhart, HM, Connolly, HM, et al. Coarctation of the aorta: lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol 2013; 62: 1020–1025.Google Scholar
5. Seirafi, PA, Warner, KG, Geggel, RL, et al. Repair of coarctation of the aorta during infancy minimizes the risk of late hypertension. Ann Thorac Surg 1998; 66: 1378–1382.CrossRefGoogle ScholarPubMed
6. O’Sullivan, JJ, Derrick, G, Darnell, R. Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure measurement. Heart 2002; 88: 163–166.Google Scholar
7. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114 (Suppl): 555–576.CrossRefGoogle Scholar
8. Bergdahl, L, Bjork, VO, Jonasson, R. Surgical correction of coarctation of the aorta. Influence of age on late results. J Thorac Cardiovasc Surg 1983; 85: 532–536.Google Scholar
9. Clarkson, PM, Nicholson, MR, Barratt-Boyes, BG, et al. Results after repair of coarctation of the aorta beyond infancy: a 10 to 28 year follow-up with particular reference to late systemic hypertension. Am J Cardiol 1983; 51: 1481–1488.Google Scholar
10. Cohen, M, Fuster, V, Steele, PM, et al. Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: 840–845.Google Scholar
11. Liberthson, RR, Pennington, DG, Jacobs, ML, et al. Coarctation of the aorta: review of 234 patients and clarification of management problems. Am J Cardiol 1979; 43: 835–840.Google Scholar
12. de Divitiis, M, Pilla, C, Kattenhorn, M, et al. Vascular dysfunction after repair of coarctation of the aorta: impact of early surgery. Circulation 2001; 104 (Suppl 1): I165–I170.Google Scholar
13. Gardiner, HM, Celermajer, DS, Sorensen, KE, et al. Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation 1994; 89: 1745–1750.Google Scholar
14. Moutafi, AC, Alissafi, T, Chamakou, A, et al. Neurohormonal activity and vascular properties late after aortic coarctation repair. Int J Cardiol 2012; 159: 211–216.Google Scholar
15. Niwa, K, Perloff, JK, Bhuta, SM, et al. Structural abnormalities of great arterial walls in congenital heart disease: light and electron microscopic analyses. Circulation 2001; 103: 393–400.Google Scholar
16. Sehested, J, Baandrup, U, Mikkelsen, E. Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation. Implications for baroreceptor function. Circulation 1982; 65: 1060–1065.CrossRefGoogle ScholarPubMed
17. Senzaki, H, Iwamoto, Y, Ishido, H, et al. Ventricular-vascular stiffening in patients with repaired coarctation of aorta: integrated pathophysiology of hypertension. Circulation 2008; 118 (Suppl 14): S191–S198.CrossRefGoogle ScholarPubMed
18. Kenny, D, Polson, JW, Martin, RP, et al. Hypertension and coarctation of the aorta: an inevitable consequence of developmental pathophysiology. Hypertens Res 2011; 34: 543–547.Google Scholar
19. Gillett, C, Wong, A, Wilson, DG, et al. Underrecognition of elevated blood pressure readings in children after early repair of coarctation of the aorta. Pediatr Cardiol 2011; 32: 202–205.Google Scholar