Interventions in Adults With Repaired Coarctation of the Aorta
Viktor Meidell Blylod1, Daniel Rinnström1,2, Johanna Pennlert1
1Department of Public Health and Clinical Medicine Umeå University Umeå Sweden.
Insights
Interventions are common after coarctation of the aorta repair, with nearly 30% of patients needing further procedures. Men face a higher risk, and interventions impact left ventricular function, highlighting the need for tailored follow-up care.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Adult Congenital Heart Disease
Background:
- Coarctation of the aorta often presents with other cardiac anomalies.
- Long-term complications like recoarctation necessitate interventions post-primary repair.
- A growing population of adults with repaired coarctation requires understanding of late outcomes.
Purpose of the Study:
- To determine the prevalence of interventions following coarctation of the aorta repair.
- To identify risk factors associated with these re-interventions.
- To assess late mortality in adults with repaired coarctation of the aorta.
Main Methods:
- Utilized the Swedish National Register of Congenital Heart Disease.
- Included 683 adults with a history of coarctation of the aorta repair.
- Analyzed freedom from re-intervention at the coarctation site, aortic valve, left ventricular outflow tract, and ascending aorta.
Main Results:
- 196 patients (29%) required at least one subsequent intervention.
- Freedom from intervention was 60% at 50 years post-repair.
- Men had a significantly higher risk (HR 1.6) of re-intervention.
- Re-interventions were associated with poorer left ventricular function.
- The standardized mortality ratio was 2.9 (95% CI, 1.7-4.3).
Conclusions:
- Subsequent interventions are frequent after coarctation of the aorta repair.
- Sex influences the risk and timing of re-interventions.
- Findings are crucial for optimizing follow-up and medical advice for adults with repaired coarctation.
Abstract:
Background Coarctation of the aorta coexists with other cardiac anomalies and has long-term complications, including recoarctation, which may require intervention after the primary coarctation repair. This study aims to clarify the prevalence of and risk factors for interventions related to the coarctation complex as well as late mortality in a large contemporary patient population. Methods and Results The Swedish National Register of Congenital Heart Disease was used, which comprised 683 adults with repaired coarctation of the aorta. Analysis was performed on freedom from intervention thereafter at the coarctation site, aortic valve, left ventricular outflow tract, or ascending aorta. One hundred ninety-six (29%) patients had at least 1 of these interventions. Estimated freedom from either of these interventions was 60% after 50 years. The risk of undergoing such an intervention was higher among men (hazard ratio, 1.6 [95% CI, 1.2-2.2]). Estimated freedom from another intervention at the coarctation site was 75% after 50 years. In women, there was an increase in interventions at the coarctation site after 45 years. Patients who underwent one of the previously mentioned interventions after the primary coarctation repair had poorer left ventricular function. Eighteen patients (3%) died during follow-up in the register. The standardized mortality ratio was 2.9 (95% CI, 1.7-4.3). Conclusions Interventions are common after coarctation repair. The risk for and time of interventions are affected by sex. Our results have implications for planning follow-up and giving appropriate medical advice to the growing population of adults with repaired coarctation of the aorta.
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