Interventions in Adults With Repaired Coarctation of the Aorta

• Published in: Journal of the American Heart Association 2022-07, Vol.11 (14), p.e023954-e023954
• Main Authors: Meidell Blylod, Viktor, Rinnström, Daniel, Pennlert, Johanna, Ostenfeld, Ellen, Dellborg, Mikael, Sörensson, Peder, Christersson, Christina, Thilén, Ulf, Johansson, Bengt
• Format: Article
• Language: English
• Subjects: Adult; adult congenital heart disease; Aorta; Aortic Coarctation - complications; Aortic Coarctation - surgery; Aortic Valve - abnormalities; Cardiac and Cardiovascular Systems; Clinical Medicine; Clinical Physiology; coarctation of the aorta; Female; Follow-Up Studies; Humans; intervention; Kardiologi; klinisk fysiologi; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; mortality; Original Research; Retrospective Studies; risk factors
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.121.023954

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.