Predictors of left ventricular outflow tract obstruction after biventricular repair in interrupted aortic arch or aortic coarctation

Yi-Chia Wang; Heng-Wen Chou; Chi-Hsiang Huang; Ming-Tai Lin; Chun-An Chen; Shuenn-Nan Chiu; Chun-Wei Lu; Yih-Sharng Chen; Shu-Chien Huang

doi:10.1016/j.jfma.2024.09.007

Predictors of left ventricular outflow tract obstruction after biventricular repair in interrupted aortic arch or aortic coarctation

J Formos Med Assoc. 2024 Sep 10:S0929-6646(24)00411-X. doi: 10.1016/j.jfma.2024.09.007. Online ahead of print.

Authors

Yi-Chia Wang¹, Heng-Wen Chou², Chi-Hsiang Huang¹, Ming-Tai Lin³, Chun-An Chen³, Shuenn-Nan Chiu³, Chun-Wei Lu³, Yih-Sharng Chen², Shu-Chien Huang⁴

Affiliations

¹ Department of Anesthesiology, National Taiwan University Hospital, Taiwan.
² Department of Surgery, National Taiwan University Hospital, Taiwan.
³ Department of Pediatrics, National Taiwan University Hospital, Taiwan.
⁴ Department of Surgery, National Taiwan University Hospital, Taiwan. Electronic address: cvshuang@gmail.com.

PMID: 39261119
DOI: 10.1016/j.jfma.2024.09.007

Abstract

Background: Left ventricular outflow tract obstruction (LVOTO) re-intervention is a significant cause of morbidity and mortality in patients with coarctation of the aorta (CoA) or interrupted aortic arch (IAA) after aortoplasty.

Methods: This retrospective study analyzed data from neonates with IAA/CoA who underwent biventricular repair between 2012 and 2022. LVOTO events were defined by the detection of color Doppler flow acceleration ≥3.0 m/s at the valvular, subvalvular, or supravalvular regions via transthoracic echocardiography, and the necessity for surgical or catheter intervention to relieve the obstruction.

Results: Among 121 neonates with CoA/IAA, 16 (13.7%) primary aortoplasty patients developed LVOTO. Additionally, one patient (25%) who underwent a staged Yasui operation developed LVOTO due to a narrowed ventricular septal defect-pulmonary atresia tunnel. During follow-up, 58% of patients with a bicuspid valve and 25% of patients with a subaortic ridge developed LVOTO. The combination of either a bicuspid valve, subaortic ridge, or an aortic valve annulus Z-score < -3.0 predicted a high re-intervention rate (7/8 [87.5%]).

Conclusions: In patients with IAA/CoA, the presence of multiple risk factors, including a bicuspid valve, subaortic ridge, and an aortic valve annulus Z-score < -3.0, is associated with a significantly increased rate of re-intervention for LVOTO.

Keywords: Bicuspid aortic valve; Coarctation; Interrupted aortic arch; Left ventricular outflow tract obstruction; Subaortic ridge.