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Repaired coarctation: a "cost-effective" approach to identify complications in adults
J Therrien1, S A Thorne, A Wright
1Jane Somerville Grown Up Congenital Heart Unit, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom. judiththerrian@hotmail.com
Insights
The most cost-effective follow-up for adults after coarctation of the aorta repair involves clinical assessment and MRI. An alternative uses clinical assessment, echocardiography, and MRI for positive cases if MRI resources are limited.
Area of Science:
- Cardiovascular Surgery
- Diagnostic Imaging
- Health Economics
Background:
- Post-coarctation of the aorta repair, recoarctation and aneurysm formation pose significant risks.
- Current screening methods lack defined sensitivities and specificities, leaving optimal follow-up strategies unclear.
Purpose of the Study:
- To determine the most cost-effective follow-up strategy for adults after coarctation of the aorta repair.
- To evaluate the diagnostic performance of various screening tests for post-repair complications.
Main Methods:
- Retrospective analysis of 84 adult patients post-coarctation of the aorta repair.
- Assessed sensitivity/specificity of clinical assessment, ECG, chest radiograph, exercise testing, and echocardiography.
- Utilized magnetic resonance imaging (MRI) as the gold standard for detecting recoarctation and/or aneurysm formation.
Main Results:
- Echocardiography showed highest sensitivity for recoarctation (87%); chest radiograph for aneurysm (67%).
- Combined clinical visit and echocardiography achieved 97% sensitivity for diagnosing complications.
- Clinical visit plus MRI for all patients emerged as the most cost-effective strategy.
Conclusions:
- A clinical assessment combined with MRI for every patient is the most cost-effective approach for diagnosing post-coarctation of the aorta repair complications.
- If MRI is limited, clinical assessment plus transthoracic echocardiography, followed by MRI for positive cases, is a viable alternative.
Objectives:
The study was done to determine the most "cost-effective" approach to follow adults after repair of coarctation of the aorta.
Background:
Recoarctation and/or aneurysm formation following surgical repair or angioplasty for coarctation of the aorta carry a significant morbidity and mortality. Various screening tests to detect such complications are used, but little is known of their sensitivities and specificities; as a consequence, the most "cost-effective" approach to follow such patients is undefined.
Methods:
Retrospective analysis was done on the sensitivity and specificity of symptomatology, physical examination, electrocardiogram, chest radiograph, exercise testing and transthoracic echocardiography to detect recoarctation and/or aneurysm formation in 84 adult patients following surgical repair or angioplasty of coarctation of the aorta, using magnetic resonance imaging (MRI) as the gold standard test.
Results:
Echocardiography had the highest sensitivity in detecting recoarctation (87%) and chest radiograph the highest sensitivity in detecting aneurysm formation (67%). Combined clinical visit and echocardiography had a high sensitivity for diagnosing recoarctation and/or aneurysm formation (97%), but performing a clinical visit and an MRI on every patient without any prior screening test emerged as the most "cost-effective" strategy.
Conclusions:
The most "cost-effective" approach to diagnose complications at the site of repair in patients after surgical repair or balloon angioplasty of coarctation of the aorta appears to be the combination of clinical assessment and MRI scan on every patient. If MRI resources are scant, performing a clinical assessment plus a transthoracic echocardiography and an MRI on patients with positive results is an acceptable alternative.