Looks Do Matter! Aortic Arch Shape After Hypoplastic Left Heart Syndrome Palliation Correlates With Cavopulmonary Outcomes

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• 作者：Jan L. Bruse ; MS^a ; Elena Cervi ; MD^a ; Kristin McLeod ; PhD^b ; ^c ; Giovanni Biglino ; PhD^a ; Maxime Sermesant ; PhD^c ; Xavier Pennec ; PhD^c ; Andrew M. Taylor ; MD^a ; Silvia Schievano ; PhD^a ; Tain-Yen Hsia ; MD^a ; ^{hsiat@gosh.nhs.uk} ; for the Modeling of Congenital Hearts Alliance (MOCHA) Collaborative Group^&lowast ; ; Andrew Taylor ; Sachin Khambadkone ; Silvia Schievano ; Marc de Leval ; T.-Y. Hsia ; Edward Bove ; Adam Dorfman ; G. Hamilton Baker ; Anthony Hlavacek ; Francesco Migliavacca ; Giancarlo Pennati ; Gabriele Dubini ; Alison Marsden ; Irene Vignon-Clementel ; Richard Figliola
• 刊名：The Annals of Thoracic Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：103
• 期：2
• 页码：645-654
• 全文大小：2060 K
• 卷排序：103

文摘

Aortic arch reconstruction after hypoplastic left heart syndrome (HLHS) palliation can vary widely in shape and dimensions between patients. Arch morphology alone may affect cardiac function and outcome. We sought to uncover the relationship of arch three-dimensional shape features with functional and short-term outcome data after total cavopulmonary connection (TCPC).MethodsAortic arch shape models of 37 patients with HLHS (age, 2.89 ± 0.99 years) were reconstructed from magnetic resonance data before TCPC completion. A novel, validated statistical shape analysis method was used to compute a three-dimensional anatomic mean shape from the cohort and calculate the deformation vectors of the mean shape toward each patient’s specific anatomy. From these deformations, three-dimensional shape features most related to ventricular ejection fraction, indexed end-diastolic volume, and superior cavopulmonary pressure were extracted by partial least-square regression analysis. Shape patterns relating to intensive care unit and hospital lengths of stay after TCPC were assessed.ResultsDistinct deformation patterns, which result in an acutely mismatched aortic root and ascending aorta, and a gothic-like transverse arch, correlated with increased indexed end-diastolic volume and higher superior cavopulmonary pressure but not with ejection fraction. Specific arch morphology with pronounced transverse arch and descending aorta mismatch also correlated with longer intensive care unit and hospital lengths of stay after TCPC completion.ConclusionsIndependent of hemodynamically important arch obstruction, altered aortic morphology in HLHS patients appears to have important associations with higher superior cavopulmonary pressure and with short-term outcomes after TCPC completion as highlighted by statistical shape analysis, which could act as adjunct to risk assessment in HLHS.