Posttransplant recoarctation of the aorta: twelve year experience

Objectives. This study was undertaken to investigate the incidence of posttransplant recoarctation of the aorta, delineate the mode of presentation, identify risk factors that predict recoarctation and examine the results of intervention for posttransplant recoarctation. Background. Patients with aortic arch hypoplasi require extended arch reconstruction at transplant, with an inherent possibility of subsequent recoarctation of the aorta. Methods. This was retrospective review of all children (age <18 years) who underwent cardiac transplantation over 10-year period. Collected dat included pretransplant diagnosis, details of the transplant procedure and posttransplant dat including development of recoarctation of the aorta, interventions for recoarctation and the most recent follow-up assessment of the aortic arch. Results. 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 patient developed recoarctation within 2 years after transplant; 87% were hypertensive at presentation. Of 30 patients who underwent intervention for recoarctation (balloon angioplasty [n = 26] and surgical repair of recoarctation [n = 4]), 26 (87%) have remained recurrence-free (follow-up = 133 patient-years; range 8 to 106 months, median 47). Conclusions. The high frequency of recoarctation after cardiac transplantation with extended aortic arch reconstruction mandates serial echocardiographic evaluation of the aortic arch. Patients typically present with systemic hypertension within the first two years after transplantation. Balloon angioplasty is safe, effective and durable method of treatment.