This study investigated the outcome after neonatal arch repair, and the usefulness
of computed tomography (CT) in predicting the development of left ventricular outflow
tract (LVOT) obstruction (LVOTO). A total of 150 neonates who underwent arch repair
between 2008 and 2019 were included. The diameters of the aortic valve annulus (AVA)
and LVOT in millimeters were measured with transthoracic echocardiography (TTE) or
CT and indexed by subtracting body weight in kilograms. The outcomes of interest were
the development of LVOTO (peak flow velocity > 3 m/s on TTE) and reintervention or
reoperation for LVOTO. The median follow-up duration was 3.6 years. The rates of overall
survival, freedom from reintervention for LVOTO, and freedom from the LVOTO development
at 7 years were 93.7%, 88.2%, and 81.0%, respectively. In univariable Cox regression
analysis, weight-indexed CT-measured LVOT diameter (concordance index [C-index] = 0.73,
P = 0.002) and weight-indexed TTE-measured AVA diameter (C-index = 0.69, P = 0.001) were significant predictors of LVOTO. The maximal chi-square test identified
the following cutoff values for predicting LVOTO: 1.4 for weight-indexed CT-measured
LVOT diameter and 1.6 for weight-indexed TTE-measured AVA diameter. The high-risk
group (both measures lower than the cutoff values) had a significantly lower rate
of freedom from LVOTO development than the low-risk group (both measures higher than
the cutoff values) (P < 0.001). The weight-indexed CT-measured LVOT diameter could be used to predict LVOTO
development after neonatal arch repair, as an independent measure or complementary
to traditional measures.
GRAPHICAL ABSTRACT
Graphical Abstract
Keywords
Abbreviations:
IAA (interrupted aortic arch), CoA (coarctation of the aorta), LVOT (left ventricular outflow tract), LVOTO (left ventricular outflow tract obstruction), AVA (aortic valve annulus), TTE (transthoracic echocardiography), CT (computed tomography), IQR (interquartile range), HR (hazard ratio), ECG (electrocardiography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 09, 2022
Footnotes
Read at the AATS 101st Annual Meeting: A Virtual Learning Experience, April 30-May 2, 2021.
IRB approval number: S2020-2585-0001
IRB approval date: October 26, 2020
The requirement for informed consent was waived owing to the retrospective nature of the study design.
This study was presented at 101st AATS annual meeting.
Funding: None.
Disclosure: None.
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© 2022 Elsevier Inc. All rights reserved.
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- Commentary: Obstruction or No Obstruction? That Is the Question. Is CT the Answer We've Been Searching for?Seminars in Thoracic and Cardiovascular SurgeryVol. 35Issue 1
- PreviewPreoperative prediction of adequate left heart structures is a critical task for congenital cardiologists and surgeons and there have been many attempts to find predictive measurements utilizing 2-dimensional transthoracic echocardiography (TTE).1–4 In this issue, Kim and colleagues5 specifically focus on neonates with aortic arch obstruction and on the predictive utility of computed tomography (CT) in determining development of postoperative left ventricular outflow tract (LVOT) obstruction (LVOTO).
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