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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*
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

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.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

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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
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