Intervention for Recoarctation in the Single Ventricle Reconstruction Trial

• DOI: 10.1161/circulationaha.112.000488
• Publication Date: 2013-07-18T04:59:16Z
• Authors: 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. Vincent; Christoph P. Hornik
• Keywords: Norwood procedure; Cardiac catheterization

Background— Recoarctation after the Norwood procedure increases risk for mortality. The Single Ventricle Reconstruction (SVR) trial randomized subjects with a single right ventricle undergoing to modified Blalock-Taussig shunt or ventricle–pulmonary artery shunt. We sought determine incidence of recoarctation, factors, and outcomes in SVR trial. Methods Results— was defined by intervention, either catheter based surgical. Univariate analysis multivariable Cox proportional hazard models were performed adjustment center. Of 549 subjects, 97 (18%) underwent 131 interventions (92 balloon aortoplasty, 39 surgical) recoarctation at median age 4.9 months (range, 1.1–10.5 months). Intervention typically occurred pre–stage II catheterization (n=71, 54%) stage surgery (n=38, 29%). In analysis, associated type place end (hazard ratio, 2.0 versus shunt; P =0.02), discharge peak echo-Doppler arch gradient 1.07 per 1 mm Hg; <0.01). Subjects demonstrated comorbidities evaluation, including higher pulmonary arterial pressures (15.4±3.0 14.5±3.5 =0.05), vascular resistance (2.6±1.6 2.0±1.0 Wood units·m 2 ; =0.04), increased echocardiographic volumes (end-diastolic volume, 126±39 112±33 mL/BSA 1.3 , where BSA is body surface area; =0.02). There no difference 12-month postrandomization transplantation-free survival between those without ( =0.14). Conclusions— common contributes comorbidities. Although intervention there increase 1-year transplantation/mortality, further evaluation warranted evaluate effects morbidities. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00115934.