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Late outcomes in adults with coarctation of the aorta

P Choudhary1, C Canniffe2, D J Jackson3

  • 1Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia Discipline of Medicine, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia.

Heart (British Cardiac Society)
|March 27, 2015
PubMed

Insights

Adults with coarctation of the aorta (CoA) have improved long-term survival, reaching 89% by age 60. However, aortic complications and hypertension remain common challenges in this population.

Area of Science:

  • Cardiology
  • Adult Congenital Heart Disease (ACHD)
  • Vascular Surgery

Background:

  • Coarctation of the aorta (CoA) historically has poor long-term survival.
  • Advances in pediatric cardiac surgery and adult congenital heart disease (ACHD) services have improved outcomes for other congenital heart defects.
  • Contemporary outcomes for adult CoA patients require updated evaluation.

Purpose of the Study:

  • To investigate long-term survival and morbidity in young adult patients with coarctation of the aorta (CoA) in the contemporary era.
  • To assess the impact of surgical repair strategies on long-term outcomes.

Main Methods:

  • A cohort of 151 adult patients with simple coarctation of the aorta (CoA) was followed at a tertiary ACHD service.
  • Data collected included mortality, re-intervention for re-coarctation, and aneurysm development.
  • Surgical repair methods and patient demographics were documented.

Main Results:

  • Actuarial survival reached 98% at ages 40 and 50, and 89% by age 60.
  • Re-coarctation occurred in 34% of patients, and descending aortic aneurysms in 18%.
  • End-to-end repair was associated with lower rates of re-coarctation and aneurysms compared to other methods.

Conclusions:

  • Adult patients with coarctation of the aorta (CoA) who survive to adolescence exhibit excellent long-term survival up to age 60.
  • Significant long-term morbidity, particularly aortic complications and hypertension, remains prevalent.
  • Optimized surgical techniques may reduce the incidence of late aortic complications.
Abstract

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