Intervention for recoarctation in the single ventricle reconstruction trial: Incidence, risk, and outcomes

Kevin D. Hill, John F. Rhodes, Ranjit Aiyagari, G. Hamilton Baker, Lisa Bergersen, Paul J. Chai, Gregory A. Fleming, J. Curt Fudge, Matthew J. Gillespie, Robert G. Gray, Russel Hirsch, Kyong Jin Lee, Jennifer S. Li, Richard G. Ohye, Matthew E. Oster, Sara K. Pasquali, Andrew N Pelech, Wolfgang A K Radtke, Cheryl M. Takao, Julie A. VincentChristoph P. Hornik

Research output: Contribution to journalArticle

37 Citations (Scopus)

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. METHODS AND 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·m2; P=0.04), and increased echocardiographic volumes (end-diastolic volume, 126±39 versus 112±33 mL/BSA, 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. CLINICAL TRIAL REGISTRATION - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00115934.

Original languageEnglish (US)
Pages (from-to)954-961
Number of pages8
JournalCirculation
Volume128
Issue number9
DOIs
StatePublished - Aug 29 2013
Externally publishedYes

Fingerprint

Norwood Procedures
Blalock-Taussig Procedure
Heart Ventricles
Pulmonary Artery
Comorbidity
Incidence
Transplantation
Mortality
Body Surface Area
Proportional Hazards Models
Catheterization
Vascular Resistance
Arterial Pressure
Catheters
Clinical Trials
Morbidity
Lung

Keywords

  • Angioplasty
  • Aortic coarctation
  • Heart defects, Congenital

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hill, K. D., Rhodes, J. F., Aiyagari, R., Baker, G. H., Bergersen, L., Chai, P. J., ... Hornik, C. P. (2013). Intervention for recoarctation in the single ventricle reconstruction trial: Incidence, risk, and outcomes. Circulation, 128(9), 954-961. https://doi.org/10.1161/CIRCULATIONAHA.112.000488

Intervention for recoarctation in the single ventricle reconstruction trial : Incidence, risk, and outcomes. / Hill, Kevin D.; Rhodes, John F.; Aiyagari, Ranjit; Baker, G. Hamilton; Bergersen, Lisa; Chai, Paul J.; Fleming, Gregory A.; Fudge, J. Curt; Gillespie, Matthew J.; Gray, Robert G.; Hirsch, Russel; Lee, Kyong Jin; Li, Jennifer S.; Ohye, Richard G.; Oster, Matthew E.; Pasquali, Sara K.; Pelech, Andrew N; Radtke, Wolfgang A K; Takao, Cheryl M.; Vincent, Julie A.; Hornik, Christoph P.

In: Circulation, Vol. 128, No. 9, 29.08.2013, p. 954-961.

Research output: Contribution to journalArticle

Hill, KD, Rhodes, JF, Aiyagari, R, Baker, GH, Bergersen, L, Chai, PJ, Fleming, GA, Fudge, JC, Gillespie, MJ, Gray, RG, Hirsch, R, Lee, KJ, Li, JS, Ohye, RG, Oster, ME, Pasquali, SK, Pelech, AN, Radtke, WAK, Takao, CM, Vincent, JA & Hornik, CP 2013, 'Intervention for recoarctation in the single ventricle reconstruction trial: Incidence, risk, and outcomes', Circulation, vol. 128, no. 9, pp. 954-961. https://doi.org/10.1161/CIRCULATIONAHA.112.000488
Hill, Kevin D. ; Rhodes, John F. ; Aiyagari, Ranjit ; Baker, G. Hamilton ; Bergersen, Lisa ; Chai, Paul J. ; Fleming, Gregory A. ; Fudge, J. Curt ; Gillespie, Matthew J. ; Gray, Robert G. ; Hirsch, Russel ; Lee, Kyong Jin ; Li, Jennifer S. ; Ohye, Richard G. ; Oster, Matthew E. ; Pasquali, Sara K. ; Pelech, Andrew N ; Radtke, Wolfgang A K ; Takao, Cheryl M. ; Vincent, Julie A. ; Hornik, Christoph P. / Intervention for recoarctation in the single ventricle reconstruction trial : Incidence, risk, and outcomes. In: Circulation. 2013 ; Vol. 128, No. 9. pp. 954-961.
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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. METHODS AND 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·m2; P=0.04), and increased echocardiographic volumes (end-diastolic volume, 126±39 versus 112±33 mL/BSA, 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. CLINICAL TRIAL REGISTRATION - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00115934.",
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TY - JOUR

T1 - Intervention for recoarctation in the single ventricle reconstruction trial

T2 - Incidence, risk, and outcomes

AU - Hill, Kevin D.

AU - Rhodes, John F.

AU - Aiyagari, Ranjit

AU - Baker, G. Hamilton

AU - Bergersen, Lisa

AU - Chai, Paul J.

AU - Fleming, Gregory A.

AU - Fudge, J. Curt

AU - Gillespie, Matthew J.

AU - Gray, Robert G.

AU - Hirsch, Russel

AU - Lee, Kyong Jin

AU - Li, Jennifer S.

AU - Ohye, Richard G.

AU - Oster, Matthew E.

AU - Pasquali, Sara K.

AU - Pelech, Andrew N

AU - Radtke, Wolfgang A K

AU - Takao, Cheryl M.

AU - Vincent, Julie A.

AU - Hornik, Christoph P.

PY - 2013/8/29

Y1 - 2013/8/29

N2 - 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. METHODS AND 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·m2; P=0.04), and increased echocardiographic volumes (end-diastolic volume, 126±39 versus 112±33 mL/BSA, 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. CLINICAL TRIAL REGISTRATION - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00115934.

AB - 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. METHODS AND 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·m2; P=0.04), and increased echocardiographic volumes (end-diastolic volume, 126±39 versus 112±33 mL/BSA, 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. CLINICAL TRIAL REGISTRATION - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00115934.

KW - Angioplasty

KW - Aortic coarctation

KW - Heart defects, Congenital

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U2 - 10.1161/CIRCULATIONAHA.112.000488

DO - 10.1161/CIRCULATIONAHA.112.000488

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JF - Circulation

SN - 0009-7322

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