Outcomes of transcatheter balloon angioplasty of obstruction in the neo-aortic arch after the Norwood operation

Obstruction of the reconstructed aortic arch, or the neoaortic arch, is now known to be an important factor increasing mortality after the Norwood ope ration fur hypoplastic left heart syndrome. Transcatheter balloon angioplas ty has been shown to provide effective relief of both native aortic coarcta tion and obstructions of the aortic arch occurring subsequent to therapeuti c intervention. We sought to determine the outcomes of balloon angioplasty used as an initial treatment for obstruction of the neoaortic arch occurrin g after the Norwood operation. We gathered the characteristics of 58 patien ts with such obstruction from 8 institutions, noting procedural factors and outcomes of initial balloon dilation. Obstruction occurred at a median int erval of 4 months, with a range from 1.5 months to 6.3 years, after a Norwo od operation. Ventricular dysfunction was present before dilation in 13 pat ients. Mean peak to peak systolic pressure gradients were acutely reduced f rom 31+/-20 mm Hg to 6+/-9 mmHg (p<0.001), with outcome subjectively judged to be successful in 89%. Three patients with pre-existing ventricular dysf unction died within 48 hours of dilation. There were 10 additional deaths d uring the period of followup, with Kaplan Meier estimates of survival after intervention of 87% at 1 month, 77% at 12 months, and 72% after 15 months. In addition, 9 patients required re-intervention during the period of foll ow-up, with Kaplan Meier estimates of freedom from re-intervention after di lation of 87% at 6 months, 78% at 12 months and 74% after 18 months. Althou gh transcatheter dilation of neoaortic arch obstructions after Norwood oper ation is successful, there is a high risk of re-intervention and ongoing mo rtality in this subgroup of patients. Close follow-up is recommended.