Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis
Introduction: Surgical treatment of aortic coarctation in low-birth-weight (LBW) neonates is associated with risks of higher hospital mortality rates and recoarctation development in the long-term. The goal of our study was to compare the results of surgical treatment of aortic coarctation in LBW ne...
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MDPI AG
2023-11-01
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| author | Aleksandra Krylova Andrey Svobodov Margarita Tumanyan Elena Levchenko Sergey Kotov Yuliya Butrim Vladimir Shvartz |
| author_facet | Aleksandra Krylova Andrey Svobodov Margarita Tumanyan Elena Levchenko Sergey Kotov Yuliya Butrim Vladimir Shvartz |
| author_sort | Aleksandra Krylova |
| collection | DOAJ |
| description | Introduction: Surgical treatment of aortic coarctation in low-birth-weight (LBW) neonates is associated with risks of higher hospital mortality rates and recoarctation development in the long-term. The goal of our study was to compare the results of surgical treatment of aortic coarctation in LBW neonates and normal-weight patients, to identify predictors of recoarctation in the long-term among LBW patients. Materials and methods: A retrospective study was performed to analyse the patients who had undergone resection of isolated aortic coarctation between 2005 and 2022. Overall analysis included 521 patients under the age of 30 days, 89 LBW patients and 432 patients with normal body weight. Propensity score matching (PSM) was performed at a ratio of 1:1 for the statistical adjustment of original patients’ data in both groups. Results: All patients underwent standard resection of aortic coarctation with extended end-to-end anastomosis. Hospital mortality among LBW patients was 8% and in patients with normal weight the mortality amounted to 1% (<i>p</i> = 0.030). LBW patients were transferred to other hospitals more often than normal-weight patients who were more often discharged (<i>p</i> < 0.001). In the long-term, period mortality was not statistically significantly different (<i>p</i> = 0.801). The freedom from reoperation in the group of normal-weight children was 87%, whereas in the LBW patients the rate was 63% (log rank test, <i>p</i> = 0.104). In the multivariate regression model, the most significant risk factors for reoperation were as follows: preoperative inotropes administration (OR (95% CI) 4.369 (1.316–14.51)) and pressure gradient across aortic arch before discharge (OR (95% CI) 1.081 (1.014–1.153)). Conclusions: Hospital mortality was higher among LBW patients (<i>p</i> = 0.030). There was a statistical trend of differences in reoperation rates: in the long-term among LBW patients, a higher reintervention probability remains. Moreover, the LBW group initially had more severe clinical condition in terms of cardiac failure and impaired renal function. Factors associated with the risk of recoarctation were preoperative inotropes infusion and pressure gradient across aortic before discharge. |
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| institution | Directory Open Access Journal |
| issn | 2075-1729 |
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| last_indexed | 2024-03-08T20:36:17Z |
| publishDate | 2023-11-01 |
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| spelling | doaj.art-dcab1b7c6ca24028a43f448652df8a062023-12-22T14:21:11ZengMDPI AGLife2075-17292023-11-011312228210.3390/life13122282Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched AnalysisAleksandra Krylova0Andrey Svobodov1Margarita Tumanyan2Elena Levchenko3Sergey Kotov4Yuliya Butrim5Vladimir Shvartz6The Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, RussiaThe Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, RussiaThe Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, RussiaThe Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, RussiaThe Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, RussiaThe Department of Intensive Cardiology for Congenital Heart Diseases of Premature Neonates and Infants, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, RussiaThe Department of Surgical Treatment for Interactive Pathology, Bakulev National Medical Research Center for Cardiovascular Surgery, Moscow 121552, RussiaIntroduction: Surgical treatment of aortic coarctation in low-birth-weight (LBW) neonates is associated with risks of higher hospital mortality rates and recoarctation development in the long-term. The goal of our study was to compare the results of surgical treatment of aortic coarctation in LBW neonates and normal-weight patients, to identify predictors of recoarctation in the long-term among LBW patients. Materials and methods: A retrospective study was performed to analyse the patients who had undergone resection of isolated aortic coarctation between 2005 and 2022. Overall analysis included 521 patients under the age of 30 days, 89 LBW patients and 432 patients with normal body weight. Propensity score matching (PSM) was performed at a ratio of 1:1 for the statistical adjustment of original patients’ data in both groups. Results: All patients underwent standard resection of aortic coarctation with extended end-to-end anastomosis. Hospital mortality among LBW patients was 8% and in patients with normal weight the mortality amounted to 1% (<i>p</i> = 0.030). LBW patients were transferred to other hospitals more often than normal-weight patients who were more often discharged (<i>p</i> < 0.001). In the long-term, period mortality was not statistically significantly different (<i>p</i> = 0.801). The freedom from reoperation in the group of normal-weight children was 87%, whereas in the LBW patients the rate was 63% (log rank test, <i>p</i> = 0.104). In the multivariate regression model, the most significant risk factors for reoperation were as follows: preoperative inotropes administration (OR (95% CI) 4.369 (1.316–14.51)) and pressure gradient across aortic arch before discharge (OR (95% CI) 1.081 (1.014–1.153)). Conclusions: Hospital mortality was higher among LBW patients (<i>p</i> = 0.030). There was a statistical trend of differences in reoperation rates: in the long-term among LBW patients, a higher reintervention probability remains. Moreover, the LBW group initially had more severe clinical condition in terms of cardiac failure and impaired renal function. Factors associated with the risk of recoarctation were preoperative inotropes infusion and pressure gradient across aortic before discharge.https://www.mdpi.com/2075-1729/13/12/2282aortic coarctationcongenital heart diseaselow birth weightprematurity |
| spellingShingle | Aleksandra Krylova Andrey Svobodov Margarita Tumanyan Elena Levchenko Sergey Kotov Yuliya Butrim Vladimir Shvartz Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis Life aortic coarctation congenital heart disease low birth weight prematurity |
| title | Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis |
| title_full | Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis |
| title_fullStr | Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis |
| title_full_unstemmed | Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis |
| title_short | Results of Aortic Coarctation Repair in Low- and Normal Birth-Weight Neonates: A Propensity Score-Matched Analysis |
| title_sort | results of aortic coarctation repair in low and normal birth weight neonates a propensity score matched analysis |
| topic | aortic coarctation congenital heart disease low birth weight prematurity |
| url | https://www.mdpi.com/2075-1729/13/12/2282 |
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