P5.06 INCREASED ARTERIAL STIFFNESS AND SYSTOLIC BLOOD PRESSURE FOLLOWING SUBCLAVIAN FLAP REPAIR FOR AORTIC COARCTATION IN INFANCY

Abstract

Objectives: To compare the effect of Subclavian Flap Repair (SFR) versus end-to-end anastomosis (EEA) on arterial stiffness and systolic blood pressure in young children with aortic coarctation. Methods: Pulse wave velocity (PWV) was measured using a pulse volume recording technique (Vicorder, Skidmore Medical, Bristol, UK) in the right arm and leg of 21 children following CoA repair without residual narrowing (SFR n=11, EEA n=10) and 18 age-matched controls. Non-invasive cardiac output was recorded to evaluate its possible contribution to elevated systolic blood pressure. Spontaneous baroreceptor reflex sensitivity (sBRS) was measured to determine if increased arterial stiffness was associated with reduced aortic baroreflex sensitivity. Results: SFR patients had significantly higher right arm systolic blood pressure (p=0.03) and PWV (p=0.02) than both EEA patients and controls (p=0.03). This difference was not seen when comparing the EEA group to controls. No statistical difference was noted between groups in lower limb PWV. There were no significant intergroup differences in stroke index or sBRS. Conclusions: Young children with SFR have higher blood pressure and stiffer upper limb arteries compared to matched children with EEA. Surgical approach may influence upper body arterial compliance and systolic blood pressure control in young children leading to implications for longer-term cardiovascular outcomes. SFR EEA Control Age at follow-up (yrs) 5.4±0.2 5.4±0.1 5.3±0. SBP (mmHg) 108.2±3.5*† 97.8±2.9 99.2±2.3 Arm PWV (m/s) 6.0±0.2*† 5.2±0.2 5.5±0.1 Leg PWV (m/s) 5.9±0.4 5.8±0.3 5.5±0.2 Stroke Index (mls/m2) 43.3±4 42.1±2.3 46.7±2.2 sBRS (ms/mmHg) 11.2±1.4 9.4±1.0 9.7±0.9 *Indicates significance (p<0.05) <>SFR and EEA. †<> SFR and Controls.