POSTTRANSPLANT RECOARCTATION OF THE AORTA - A 12 YEAR EXPERIENCE

Objectives. This study was undertaken to investigate the incidence of posttransplant recoarctation of the aorta, delineate the mode of prese ntation, identify risk factors that predict recoarctation and examine the results of intervention for posttransplant recoarctation. Backgrou nd. Patients with aortic arch hypoplasia require ex:tended arch recons truction at transplant, with an inherent possibility of subsequent rec oarctation of the aorta. Methods. This was a retrospective review of a ll children (age <18 years) who underwent cardiac transplantation over a 10-year period. Collected data included pretransplant diagnosis, de tails of the transplant procedure and posttransplant data including de velopment of recoarctation of the aorta, interventions for recoarctati on and the most recent follow up assessment of the aortic arch. Result s. Two hundred eighty-eight transplants were performed on 279 children (follow-up = 1,075 patient-years; range 0 to 133 months, median 43.7) . Thirty-two of 152 patients (21%) who underwent extended aortic arch reconstruction subsequently developed recoarctation. All but one patie nt developed recoarctation within 2 years after transplant; 87% were h ypertensive at presentation. Of 30 patients who underwent intervention for recoarctation (balloon angioplasty [n = 26] and surgical repair o f recoarctation [n = 4]), 26 (87%) have remained recurrence-free (foll ow-up = 133 patient-years; range 8 to 106 months, median 47). Conclusi ons. The high frequency of recoarctation after cardiac transplantation with extended aortic arch reconstruction maa dates serial echocardiog raphic evaluation of the aortic arch. Patients typically present with systemic hypertension within the first two years after transplantation . Balloon angioplasty is a safe, effective and durable method of treat ment.