Elastic properties of aorta after different types of surgical correction of aorta coarctation: a prospective cohort study

Objective. To assess changes of elastic properties of the aortic wall in patients with aorta coarctation and aortic arch hypoplasia after reverse left subclavian flap aortoplasty and extended end-to-end anastomosis compared to the control group of children without cardiovascular pathology.

Design and methods. A two-center prospective cohort study was designed to assess elastic properties of the aorta in 54 patients, who underwent surgical treatment of aorta coarctation by reverse left subclavian flap aortoplasty (I group, 27 patients) and extended end-to-end anastomosis technique (II group, 27 patients) in infancy. The control group included 27 children without any congenital heart pathology.

Results. Two patients in the I group (7,7 %) and 8 patients in the II group (30,7 %) had blood pressure above 95th percentile, while in the control group none of the patients had blood pressure higher than 95th percentile (p < 0,01). Elastic properties of precoarctation area significantly differed in both groups throughout the follow-up period, while the elasticity of the descending aortic wall differed between groups only 6 months after surgery.

Conclusions. Elastic properties of the aortic wall in patients with aorta coarctation remain impaired, even after early neonatal surgical treatment. Due to the decrease in the elasticity of ascending and descending aorta, we consider a systemic genesis of vascular damage following the remodeling of aortic arches. However, this hypothesis requires further prospective studies.

1. Сойнов И. А., Синельников Ю. С., Горбатых А. В. Ничай Н. Р., Иванцов С. М., Корнилов И. А. и др. Артериальная гипертензия у пациентов после коррекции коарктации и гипоплазии дуги аорты. Патология кровообращения и кардиохирургия. 2015;2:102–113. [Soynov IA, Sinelnikov YS, Gorbatykh AV, Nichay NR, Ivanzov SM, Kornilov IA et al. Arterial hypertension in patients with repaired coarctation and hypoplastic aortic arch. Patologiya Krovoobrascheniya i Kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2015;2:102–113. In Russian].

2. O’Sullivan JJ. Late hypertension in patients with repaired aortic coarctation. Curr Hypertens Rep. 2014;16(3):421–426. doi: 10.1007/ s11906–014–0421–4

3. Toro-Salazar OH, Steinberger J, Thomas W, Rocchini AP, Carpenter B, Moller JH. Long- term follow-up of patients after coarctation of the aorta repair. Am J Cardiol. 2002;89(5):541–547. doi: 10.1016/S0002–9149(01)02293–7

4. Cohen M, Fuster V, Steele P, McGoon D. Coarctation of the aorta: long-term follow up and prediction of outcome after surgical correction. Circulation.1989;80(4):840–845. doi: 10.1161/01.CIR.80.4.840

5. Синельников Ю. С., Кшановская М. С., Прохорова Д. С., Нарциссова Г. П., Горбатых А. В., Иванцов С. М. и др. Хирургическая коррекция коарктации аорты, всегда ли оправданы ожидания? Сибирский медицинский журнал. 2013;28 (4):55–58. [Sinelnikov YuS, Kshanovskaya MS, Prokhorova DS, Nartsissova GP, Gorbatych AV, Ivanzov SM. Surgical correction of aortic coarctation: does it always satisfy expectation? Sibirskiy Meditsinskiy Zhurnal = Siberian Medical Journal. 2013;28 (4):55–58. In Russian].

6. Vogt М, Kühn А, 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(24):3269–3273. doi: 10.1161/CIR.104.529792

7. Kuhn A, Baumgartner C, Horer J, Schreiber C, Hess J, Vogt M. Impaired elastic properties of the ascending aorta persist within the first three years of neonatal coarctation repair. Pediatr Cardiol. 2009;30:46–51. doi: 10.1007/s00246–008–9280–6

8. Сойнов И. А., Синельников Ю. С., Кливер Е. Э., Корнилов И. А., Ничай Н. Р., Горбатых А. В. и др. Морфологические особенности брахиоцефальных артерий у пациентов с гипоплазией дуги аорты. Патология кровообращения и кардиохирургия. 2015;4:14–18. [Soynov IA, Sinelnikov YS, Kliver EE, Kornilov IA, Nichay NR, Gorbatykh AV et al. Morphological features of brachiocephalic arteries in patients with hypoplastic aortic arch. Patologiya Krovoobrascheniya i Kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2015;4:14–18. In Russian].

9. Machii M, Becket A. Hypoplastic aortic arch morphology pertinent to growth after surgical correction of aortic coarctation. Ann Thorac Surg. 1997;64(2):516–520. doi: 10.1016/S0003–4975(97)00444‑X

10. Горбатых Ю. Н., Синельников Ю. С., Сойнов И. А., Корнилов И. А., Кшановская М. С., Горбатых А. В. и др. Хирургическая коррекция аномалий дуги аорты у младенцев в условиях искусственного кровообращения. Хирургия. 2015;8:18–21. [Gorbatykh IuN, Sinelnikov IuS, Soynov IA, Kornilov IA, Kshanovskaya MS, Gorbatykh AV et al. Surgical treatment of aortic arch malformations in infants under cardiopulmonary bypass. Khirurgiya = Surgery. 2015;8:18–21. In Russian]. doi:10.17116/hirurgia2015818–21

11. Sciolaro C, Copeland J, Cork R, Barkenbush M, Donnerstein R, Goldberg S. Long-term follow-up comparing subclavian flap angioplasty to resection with modified oblique end-to- end anastomosis. J Thorac Cardiovasc Surg. 1991;101(1):1–13.

12. Pandey R, Jackson M, Ajab S, Gladman G, Pozzi M. Subclavian flap repair: review of 399 patients at median follow-up of fourteen years. Ann Thorac Surg. 2006;81(4):1420–1428. doi: 10.1016/j.athoracsur.2005.08.070

13. Сойнов И. А., Синельников Ю. С., Корнилов И. А., Ничай Н. Р., Гасанов Э. Н., Кулябин Ю. Ю. и др. Хирургическая коррекция коарктации аорты с гипоплазией дистальной дуги у пациентов раннего возраста. Патология кровообращения и кардиохирургия. 2016;2:66–73. [Soynov IA, Sinelnikov YS, Kornilov IA, Nichay NR, Gasanov EN, Kulyabin YY et al. Surgical correction of coarctation of the aorta with distal aortic arch hypoplasia in infants. Patologiya Krovoobrascheniya i Kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2016;2:66–73. In Russian]. doi: 10.21688-1681-3472-2016-2-66-73

14. Pettersen MD, Du W, Skeens ME, Humes RA. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr. 2008;21(8):922– 934. doi: 10.1016/j.echo.2008.02.006

15. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth on the diagnosis and treatment of the high blood pressure in children and adolescents. Pediatrics. 2004;114(2):555–576.

16. Реброва О. Ю. Статистический анализ медицинских данных. М.: Медиа Сфера, 2002. 312 c. [Rebrova OYu. Statistical analysis of medical data. Moscow: MediaSphera, 2002. 312 p. In Russian].

17. Vitarelli A, Giordano M, Germano G, Pergolini M, Cicconetti P, Tomei F et al. Assessment of ascending aorta wall stiffness in hypertensive patients by tissue Doppler imaging and strain Doppler echocardiography. Heart. 2010;96(18):1469–1474. doi: 10.1136/hrt.2010.198358

18. 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(12 Suppl 1):165–170. doi: 10.1161/hc37tl.094900

19. 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. J Am Coll Cardiol. 2007;49(8):883–890. doi: 10.1016/j.jacc.2006.10.057

20. Brili S, Antonopoulos AS, Oikonomou E, Kalampogias A, Papamikroulis G, Chrysochoou C at al. Impairment of arterial elastic properties and elevated circulation levels of transforming growth factor-beta in subjects with repaired coarctation of aorta. Intern J Cardiol. 2016;207:282–283. doi: 10.1016/j.ijcard.2016.01.168

21. Yasmin A, Wallace S, McEniery CM, Dakham Z, Pusalkar P, Maki-Petaja K et al. Matrix metalloproteinase‑9 (MMP‑9), MMP‑2, and serum elastase activity are associated with systolic hypertension and arterial stiffness. Arterioscler Thromb Vasc Biol. 2005;25 (2):372– 378. doi: 10.1161/01.ATV.0000151373.33830.41

22. Fontana V, Silva PS, Gerlach RF, Tanus-Santos TE. Circulating matrix metalloproteinases and their inhibitors in hypertension. Clinica Chimica Acta. 2012;413(7–8):656–662. doi: 10.1016/j.cca.2011.12.021

23. Garcia VP, Rocha HNM, Silva GM, Amaral TAG, Secher NH, Nobrega ACL et al. Exogenous L‑arginine reduces matrix metalloproteinase‑2 and –9 activities and oxidative stress in patients with hypertension. Life Sciences. 2016;157:125–30. doi: 10.1016/j.lfs.2016.06.006

24. McEniery CM, Yasmin, Wallace S, Maki-Petaja K, McDonnell B, Sharman JE et al. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension. 2005;46(1):221–226. doi:10.1161/01.HYP.0000165310.84801.e0

25. Kenny D, Polson J, Martin R, Caputo M, Wilson D, Cockcroft J et al. Relationship of aortic pulse wave velocity and baroreceptor reflex sensitivity to blood pressure control in patients with repaired coarctation of the aorta. Am Heart J. 2011;162(2):398–404. doi: 10.1016/j.ahj.2011.03.029