Surgical approach for aortic coarctation influences arterial compliance and blood pressure control

Damien Kenny, Jaimie W. Polson, Robin P. Martin, Dirk G. Wilson, Massimo Caputo, John R. Cockcroft, Julian F R Paton, Andrew R. Wolf

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    20 Citations (Scopus)

    Abstract

    Background: Increased arterial stiffness is linked to hypertension in adults after surgical repair for coarctation of the aorta. We evaluated the influence of surgical approaches, namely, subclavian flap repair (SFR) and end-to-end anastomosis (EEA), on arterial stiffness, blood pressure, cardiac output, and cardiac baroreceptor function in a cohort of young children after coarctation repair to determine if the surgical approach influenced longer term blood pressure control. Methods: We measured pulse wave velocity in 21 children with a mean age of 5 years, after early (less than 6 months) coarctation repair (SFR, n = 11; EEA, n = 10), and compared these with 18 matched controls. Blood pressure was recorded on three occasions from the right arm. Cardiac output was recorded using a transthoracic bioimpedence technique. We measured spontaneous baroreceptor reflex sensitivity to evaluate whether increased arterial stiffness was associated with reduced aortic baroreflex sensitivity. Results: Right arm systolic blood pressure (108.3 ± 3.5 mm Hg SFR versus 97.8 ± 2.9 mm Hg EEA, p = 0.03) and pulse wave velocity (6.0 ± 0.2 ms-1 SFR versus 5.2 ± 0.2 ms-1 EEA, p = 0.02) were significantly greater in the SFR compared with EEA group. Blood pressure and pulse wave velocity were also higher in the SFR group compared with controls. These differences were not demonstrated when comparing the EEA group with controls. There was no difference in stroke volume, spontaneous baroreceptor reflex sensitivity, or heart rate or blood pressure variability between the groups. Conclusions: Young children undergoing SFR have higher blood pressure and stiffer upper limb arteries compared with matched children undergoing EEA. Our data suggest that better longer-term cardiovascular outcome is to be expected with the EEA surgical approach.

    Original languageEnglish
    Pages (from-to)600-604
    Number of pages5
    JournalAnnals of Thoracic Surgery
    Volume90
    Issue number2
    DOIs
    Publication statusPublished - Aug 2010

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    Kenny, D., Polson, J. W., Martin, R. P., Wilson, D. G., Caputo, M., Cockcroft, J. R., ... Wolf, A. R. (2010). Surgical approach for aortic coarctation influences arterial compliance and blood pressure control. Annals of Thoracic Surgery, 90(2), 600-604. https://doi.org/10.1016/j.athoracsur.2010.04.098