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Media type:
E-Article
Title:
Is the medical treatment for arterial hypertension after primary aortic coarctation repair related to age at surgery? A retrospective cohort study
Contributor:
Lillitos, Peter J;
Nassar, Mohamed S.;
Tibby, Shane M;
Simmonds, Joy;
Salih, Caner;
Austin, Conal;
Anderson, David;
Krasemann, Thomas
Description:
<jats:title>Abstract</jats:title><jats:sec id="S1047951117001019_abs1" sec-type="general"><jats:title>Background</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="S1047951117001019_abs2" sec-type="objectives"><jats:title>Objectives</jats:title><jats:p>The objective of this study was to evaluate the risk of future medical treatment for hypertension depending on age of primary coarctation repair.</jats:p></jats:sec><jats:sec id="S1047951117001019_abs3" sec-type="methods"><jats:title>Methods</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="S1047951117001019_abs4" sec-type="results"><jats:title>Results</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="S1047951117001019_abs5" sec-type="conclusions"><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>