Prediction of recurrent coarctation by early postoperative blood pressure gradient T. K. Susheel Kumar, MD, David Zurakowski, PhD, Rishika Sharma, MD,

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Presentation transcript:

Prediction of recurrent coarctation by early postoperative blood pressure gradient T. K. Susheel Kumar, MD, David Zurakowski, PhD, Rishika Sharma, MD, Shawnjeet Saini, MS, Richard A. Jonas, MD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 5, Pages 1130-1136.e1 (November 2011) DOI: 10.1016/j.jtcvs.2011.02.048 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Line graph of ascending aorta z scores for group A (n = 66) at baseline and 3-month follow-up depicting a highly significant increase in size (z = −0.55 to z = 0.25, P < .0001). Mean values are denoted by horizontal bars. B, Line graph of ascending aorta z scores for group B (n = 11) at baseline and time of balloon angioplasty depicting an increase (z = −1.22 to z = −0.75, P = .083); however, this did not reach significance because of patient variability. Mean values are denoted by horizontal bars. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1130-1136.e1DOI: (10.1016/j.jtcvs.2011.02.048) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Line graph of transverse arch z scores for group A (n = 66) at baseline and 3 months postoperatively depicting a highly significant increase (z = −2.61 to z = −0.35, P < .0001). Mean values are denoted by horizontal bars. B, Line graph of transverse arch z scores for group B (n = 11) at baseline and time of balloon angioplasty depicting a significant increase (z = −3.04 to z = −2.01, P = .016), although the size of arch for most patients remained small. Mean values are denoted by horizontal bars. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1130-1136.e1DOI: (10.1016/j.jtcvs.2011.02.048) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Bar chart illustrating a higher mean systolic gradient for group B from the end of surgery to discharge (P < .001), with asterisks denoting statistical significance. Gradients were 2 times greater in group B at discharge and more than 6 times greater at balloon angioplasty for group B compared with group A at 3 months follow-up. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1130-1136.e1DOI: (10.1016/j.jtcvs.2011.02.048) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 ROC curves showing excellent accuracy of systolic gradient to discriminate patients in whom reCoA did and did not develop, particularly gradient at discharge (AUC = 0.888). The optimal cutoff value of greater than 13 mm Hg corresponds to 91% sensitivity (10/11 patients, group B) and 76% specificity (50/66 patients, group A). Dashed 45-degree line represents the line of nondiscrimination (equivalent to a coin toss). AUC, Area under the curve. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1130-1136.e1DOI: (10.1016/j.jtcvs.2011.02.048) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Kaplan–Meier freedom from reCoA with steps along the curve indicating time points at which the 11 patients had a reCoA. At 24 months after surgery, 87% of patients are free from reCoA. Error bars denote 95% confidence limits. Numbers in parentheses are patients at risk but still free from reCoA. For example, reCoA had not developed in 59 patients at 24-month follow-up. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1130-1136.e1DOI: (10.1016/j.jtcvs.2011.02.048) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Kaplan–Meier curves depict a significantly higher rate of reCoA for patients with a discharge gradient > 13 mm Hg compared with ≤ 13 mm Hg (P < .0001). At discharge, reCoA had developed in only 1 patient of 51 with a gradient ≤ 13 mm Hg compared with 10 of 26 patients (38%) with gradients > 13 mm Hg. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1130-1136.e1DOI: (10.1016/j.jtcvs.2011.02.048) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions