Impact of re-coarctation following the norwood operation on survival in the balloon angioplasty era

Ilana Zeltser, Jondavid Menteer, J. William Gaynor, Thomas L. Spray, Bernard J. Clark, Jacqueline Kreutzer, Jonathan J. Rome

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46 Scopus citations

Abstract

OBJECTIVES: The objective of this study was to determine the efficacy of balloon angioplasty (BA) by comparing the immediate and long-term outcomes of patients with and without re-coarctation after a Norwood procedure. BACKGROUND: Although BA has become the standard means for treating recurrent coarctation following a Norwood operation, it has been suggested that re-coarctation remains a significant cause of morbidity and mortality. METHODS: Patients who survived a Norwood operation from December 1986 through June 2001 were studied. Differences between groups were evaluated by t test and logistic regression. Survival differences were tested by log-rank tests using Kaplan-Meier survival curves. RESULTS: Fifty-eight of 633 patients underwent treatment for re-coarctation (9.2%). Thirty-five patients underwent BA (before 1988, 23 had surgery). Median age at catheterization was 6.6 months (1.9 to 35.6 months). Balloon angioplasty was successful (gradient <10 mm Hg) in 32 of 35 patients (92%). There were no BA-related deaths or neurologic complications. Recurrent obstruction after BA occurred in seven patients (20%); five underwent re-dilation. Kaplan-Meier estimates of freedom from recurrent obstruction after initial BA were 97% at one month, 79% at one year, and 79% at five years. There were no differences in survival between patients with re-coarctation treated by BA and patients who did not undergo treatment for re-coarctation. CONCLUSIONS: We found that 9.2% of patients underwent treatment for re-coarctation following a Norwood operation. Balloon angioplasty is effective, with low morbidity, no early mortality, and no difference in long-term survival when compared with patients who did not have re-coarctation. Recurrent coarctation following BA occurred in 17% of patients, usually within the first year after BA.

Original languageEnglish (US)
Pages (from-to)1844-1848
Number of pages5
JournalJournal of the American College of Cardiology
Volume45
Issue number11
DOIs
StatePublished - Jun 7 2005

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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