A Meta-Analysis for Postoperative Alternations of Aortic Coarctation

Authors

  • Yu Bao Department of Cardiovascular Surgery, Yan’an Affiliated Hospital of Kunming Medical University, 65000 Kunming, Yunnan, China; Key Laboratory of Cardiovascular Disease of Yunnan Province, 65000 Kunming, Yunnan, China; Yunnan Province Clinical Medicine Center for Cardiovascular Disease, 65000 Kunming, Yunnan, China
  • Zhao Wang Department of Cardiovascular Surgery, Yan’an Affiliated Hospital of Kunming Medical University, 65000 Kunming, Yunnan, China; Key Laboratory of Cardiovascular Disease of Yunnan Province, 65000 Kunming, Yunnan, China; Yunnan Province Clinical Medicine Center for Cardiovascular Disease, 65000 Kunming, Yunnan, China
  • Sibi Shan Department of Cardiovascular Surgery, Yan’an Affiliated Hospital of Kunming Medical University, 65000 Kunming, Yunnan, China
  • Xiang Wang Department of Cardiovascular Surgery, Yan’an Affiliated Hospital of Kunming Medical University, 65000 Kunming, Yunnan, China
  • Yuan Gong Department of Cardiovascular Surgery, Yan’an Affiliated Hospital of Kunming Medical University, 65000 Kunming, Yunnan, China

DOI:

https://doi.org/10.59958/hsf.7001

Keywords:

coarctation of aorta, carotid intima-media thickness, flow mediated vasodilation, meta-analysis

Abstract

Objective: To investigate postoperative vascular changes of patients with coarctation of the aorta (CoA). Methods: Literature review of updated articles was performed in June 2023 through the following databases: PubMed, Web of Science, EMBASE, Crohrane Library, CNKI and Wanfang database. All the case-control studies regarding the postoperative changes of vascular structure and function in patients with CoA were analyzed. Results: A total of 596 articles from the above databases were initially identified, with 10 articles being selected for meta-analysis. The analysis showed that weighted mean difference (WMD) of carotid intima-media thickness (cIMT) was 0.07 (95% CI = 0.01~0.13, p < 0.01) and WMD of flow mediated dilation (FMD) was –4.36 (95% CI = –7.49~–1.24, p < 0.01), respectively. The postoperative cIMT of CoA patients was higher than that of the control group, but the postoperative FMD was lower than that of the control group. Conclusions: The operation on CoA patients ameliorates anatomical deformity in the vascular structures. However, intima-media thickening and endothelial malfunction remain as the key postoperative issues.

References

Kim YY, Andrade L, Cook SC. Aortic Coarctation. Cardiology Clinics. 2020; 38: 337–351.

Ding P, Chen F, Qi J, Peng W, Wu K, Ding J, et al. Perioperative Brain Injury in Children with Aortic Arch Anomalies: A Retrospective Study of Risk Factors and Outcomes. Pediatric Cardiology. 2023. (online ahead of print)

Ungerleider RM, Pasquali SK, Welke KF, Wallace AS, Ootaki Y, Quartermain MD, et al. Contemporary patterns of surgery and outcomes for aortic CoArctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. The Journal of Thoracic and Cardiovascular Surgery. 2013; 145: 150–157.

Rajbanshi BG, Joshi D, Pradhan S, Gautam NC, Timala R, Shakya U, et al. Primary surgical repair of CoArctation of the aorta in adolescents and adults: intermediate results and consequences of hypertension. European Journal of Cardio-thoracic Surgery: Official Journal of the European Association for Cardio-thoracic Surgery. 2019; 55: 323–330.

Yogeswaran V, Connolly HM, Al-Otaibi M, Ammash NM, Warnes CA, Said SM, et al. Prognostic Role of Hypertensive Response to Exercise in Patients With Repaired CoArctation of Aorta. The Canadian Journal of Cardiology. 2018; 34: 676–682.

Lo MH, Lin IC, Lu PC, Huang CF, Chien SJ, Hsieh KS, et al. Evaluation of endothelial dysfunction, endothelial plasma markers, and traditional metabolic parameters in children with adiposity. Journal of the Formosan Medical Association. 2019; 118: 83–91.

Shechter M, Shechter A, Koren-Morag N, Feinberg MS, Hiersch L. Usefulness of brachial artery flow-mediated dilation to predict long-term cardiovascular events in subjects without heart disease. The American Journal of Cardiology. 2014; 113: 162–167.

Sabri MR, Daryoushi H, Gharipour M. Endothelial function state following repair of cyanotic congenital heart diseases. Cardiology in the Young. 2015; 25: 222–227.

Reiner B, Oberhoffer R, Häcker AL, Ewert P, Müller J. Carotid Intima-Media Thickness in Children and Adolescents With Congenital Heart Disease. The Canadian Journal of Cardiology. 2018; 34: 1618–1623.

Remmele J, Willinger L, Oberhoffer-Fritz R, Ewert P, Müller J. Increased carotid intima-media thickness and reduced health-related physical fitness in children and adolescents with coarctation of the aorta. International Journal of Cardiology Congenital Heart Disease. 2022; 8: 100390.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research Ed.). 2021; 372: n71.

Jiang WH, Chen BW, Zheng JG, Li J. Application of R language meta-package in meta-analysis. Evidence-Based Medicine. 2011; 11: 305–309.

Baykan A, Demiraldi AG, Tasci O, Pamukcu O, Sunkak S, Uzum K, et al. Is hypertension the fate of aortic CoArctation patients treated with Cheatham Platinum (CP) stent? Journal of Interventional Cardiology. 2018; 31: 244–250.

Cuypers J, Leirgul E, Larsen TH, Berg A, Omdal TR, Greve G. Assessment of vascular reactivity in the peripheral and coronary arteries by Cine 3T-magnetic resonance imaging in young normotensive adults after surgery for CoArctation of the aorta. Pediatric Cardiology. 2013; 34: 661–669.

de Divitiis M, Pilla C, Kattenhorn M, Zadinello M, Donald A, Leeson P, et al. Vascular dysfunction after repair of CoArctation of the aorta: impact of early surgery. Circulation. 2001; 104: I165–I170.

Gardiner HM, Celermajer DS, Sorensen KE, Georgakopoulos D, Robinson J, Thomas O, et al. Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic CoArctation in childhood. Circulation. 1994; 89: 1745–1750.

Heger M, Willfort A, Neunteufl T, Rosenhek R, Gabriel H, Wollenek G, et al. Vascular dysfunction after CoArctation repair is related to the age at surgery. International Journal of Cardiology. 2005; 99: 295–299.

Jesus CA, Assef JE, Pedra SRFF, Ferreira WP, Davoglio TA, Petisco ACGP, et al. Serial assessment of arterial structure and function in patients with CoArctation of the aorta undergoing stenting. The International Journal of Cardiovascular Imaging. 2016; 32: 729–739.

Meyer AA, Joharchi MS, Kundt G, Schuff-Werner P, Steinhoff G, Kienast W. Predicting the risk of early atherosclerotic disease development in children after repair of aortic CoArctation. European Heart Journal. 2005; 26: 617–622.

Ou P, Celermajer DS, Mousseaux E, Giron A, Aggoun Y, Szezepanski I, et al. Vascular remodeling after "successful" repair of CoArctation: impact of aortic arch geometry. Journal of the American College of Cardiology. 2007; 49: 883–890.

Trojnarska O, Mizia-Stec K, Gabriel M, Szczepaniak-Chicheł L, Katarzyńska-Szymańska A, Grajek S, et al. Parameters of arterial function and structure in adult patients after CoArctation repair. Heart and Vessels. 2011; 26: 414–420.

Wybraniec MT, Mizia-Stec K, Trojnarska O, Chudek J, Czerwieńska B, Wikarek M, et al. Low plasma renalase concentration in hypertensive patients after surgical repair of Coarctation of aorta. Journal of the American Society of Hypertension: JASH. 2014; 8: 464–474.

Ghorbannia A, Maadooliat M, Woods RK, Audi SH, Tefft BJ, Chiastra C, et al. Aortic Remodeling Kinetics in Response to Coarctation-Induced Mechanical Perturbations. Biomedicines. 2023;11: 1817.

Zeng Jiemin, Huang Ping, Wang Hongying, Yuan Jia, Zhang Li, et al. Short-term and medium-term follow-up of vascular endothelial function after correction of aortic CoArctation. 2016; 32: 1247–1249.

Brown ML, Burkhart HM, Connolly HM, Dearani JA, Cetta F, Li Z, et al. CoArctation of the aorta: lifelong surveillance is mandatory following surgical repair. Journal of the American College of Cardiology. 2013; 62: 1020–1025.

Vriend JWJ, de Groot E, Bouma BJ, Hrudova J, Kastelein JJP, Tijssen JGP, et al. Carotid intima-media thickness in post-CoArctectomy patients with exercise induced hypertension. Heart (British Cardiac Society). 2005; 91: 962–963.

Luijendijk P, Bouma BJ, Vriend JWJ, Groenink M, Vliegen HW, de Groot E, et al. Beneficial effect of high dose statins on the vascular wall in patients with repaired aortic CoArctation? International Journal of Cardiology. 2014; 176: 40–47.

Trojnarska O, Szczepaniak-Chicheł L, Mizia-Stec K, Gabriel M, Bartczak A, Grajek S, et al. Vascular remodeling in adults after CoArctation repair: impact of descending aorta stenosis and age at surgery. Clinical Research in Cardiology: Official Journal of the German Cardiac Society. 2011; 100: 447–455.

Swan L, Kraidly M, Vonder Muhll I, Collins P, Gatzoulis MA. Surveillance of cardiovascular risk in the normotensive patient with repaired aortic CoArctation. International Journal of Cardiology. 2010; 139: 283–288.

Thijssen DHJ, Bruno RM, van Mil ACCM, Holder SM, Faita F, Greyling A, et al. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. European Heart Journal. 2019; 40: 2534–2547.

Vogt M, Kühn A, Baumgartner D, Baumgartner C, Busch R, Kostolny M, et al. Impaired elastic properties of the ascending aorta in newborns before and early after successful CoArctation repair: proof of a systemic vascular disease of the prestenotic arteries? Circulation. 2005; 111: 3269–3273.

Leeson CP, Whincup PH, Cook DG, Donald AE, Papacosta O, Lucas A, et al. Flow-mediated dilation in 9- to 11-year-old children: the influence of intrauterine and childhood factors. Circulation. 1997; 96: 2233–2238.

Published

2024-01-21

How to Cite

Bao, Y., Wang, Z., Shan, S., Wang, X., & Gong, Y. (2024). A Meta-Analysis for Postoperative Alternations of Aortic Coarctation. The Heart Surgery Forum, 27(1), E068-E075. https://doi.org/10.59958/hsf.7001

Issue

Section

Systematic Review