Late complication rates after aortic coarctation repair in patients with or without a bicuspid aortic valve.

Abstract

OBJECTIVE:

Patients with previously repaired aortic coarctation (CoA) are at risk of developing late surgical complications. Many patients with CoA also have a bicuspid aortic valve (BAV). We sought to determine in patients with repaired CoA whether the presence of BAV is associated with more cardiovascular reinterventions during follow-up.

METHODS:

Adults with previously repaired simple CoA were recruited from our Adult Congenital Heart Disease database (Sydney, Australia). The incidence of complications relating to the 'CoA-site' (descending aortic aneurysm or dissection, or recoarctation) and the 'AV/AscAo' (aortic valve or ascending aortic pathology) that required intervention was compared between those with BAV ('CoA-BAV') and without BAV ('CoA-only').

RESULTS:

Of 146 patients with repaired CoA, 101 (69%) had BAV. Age at CoA repair was similar (median 6.0 (IQR 0.5-14.0) years vs 5.0 (IQR 0.5-11.0) years, p=0.44), as was the distribution of repair types, with end-to-end repair the most common in both groups (45.9% vs 45.6%). At a median of 28 years following initial repair, a significantly higher proportion of patients with CoA-BAV required cardiovascular reintervention (45.5% vs 20.0%, p=0.003). Whereas 'CoA-site' complications were more common than 'AV/AscAo' complications in patients with CoA only (13.3% and 0%, respectively), patients with CoA-BAV had a high prevalence of both 'CoA-site' as well as 'AV/AscAo' complications (19.8% and 21.8%, respectively). Overall survival was similar (p=0.42).

CONCLUSION:

In adults with repaired CoA, patients with CoA-BAV are more than twice as likely to require cardiovascular reintervention by early-to-mid-adult life compared with those with CoA alone. Despite this, no difference in survival outcomes was observed.

• Authors: Michelle S Lim, Rachael Cordina, Irina Kotchetkova, David S Celermajer
• Journal: Heart (British Cardiac Society) (Heart) Vol. 108 Issue 11 Pg. 855-859 (05 12 2022) ISSN: 1468-201X [Electronic] England
• PMID: 34535439 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Adult
• Humans
• Aortic Coarctation (complications, epidemiology, surgery)
• Aortic Valve (abnormalities, surgery)
• Bicuspid Aortic Valve Disease
• Heart Defects, Congenital (complications)
• Heart Valve Diseases (epidemiology)
• Retrospective Studies