Risk factors for aortic complications in adults with coarctation of the aorta.

OBJECTIVES We sought to determine the prevalence and predisposing condition for aortic wall complications in adults with either repaired or non-repaired coarctation of the aorta. BACKGROUND Aortic wall complications may develop in adults with coarctation of the aorta, despite successful surgical repair in childhood. METHODS A total of 235 adults with coarctation (mean age 27 +/- 13 years) were retrospectively reviewed. Treatment had been performed by surgery in 181 patients (group I) or by balloon angioplasty or stenting in 28 patients (group II). No previous intervention had been carried out in 26 patients with mild coarctation at diagnosis (group III). RESULTS Forty-four aortic wall complications were found in 37 patients (16%). There were no differences among the three groups with respect to total complications (15%, 18%, and 15%, respectively), ascending aortic aneurysms (9%, 11%, and 12%), or descending aortic aneurysms (4% in all three groups). Multivariate analysis did not show a significant relationship between previous repair, type of repair, age at repair, residual Doppler pressure gradient, or systemic hypertension and the occurrence of aortic complications. Only aging (risk ratio [RR] 1.4 per decade of age, 95% confidence interval [CI] 1.1 to 1.8, p = 0.002) and bicuspid aortic valve (RR 3.2, 95% CI 1.3 to 7.5, p = 0.005) were significantly related to these complications. CONCLUSIONS Aortic wall complications are frequent in adults with coarctation of the aorta beyond that attributable to associated hemodynamic derangement or previous repair. The only independent risk factors appear to be advanced age and bicuspid aortic valve.

[1]  R. Marsan,et al.  Ruptured aneurysm 20 years after surgery for coarctation of the aorta. , 1977, AJR. American journal of roentgenology.

[2]  A. Rocchini,et al.  Aortic aneurysm after patch aortoplasty repair of coarctation: a prospective analysis of prevalence, screening tests and risks. , 1989, Journal of the American College of Cardiology.

[3]  C. Nienaber,et al.  Predictors of aneurysmal formation after surgical correction of aortic coarctation. , 2002, Journal of the American College of Cardiology.

[4]  R. Hetzer,et al.  Morphometric analysis of aortic media in patients with bicuspid and tricuspid aortic valve. , 2002, The Annals of thoracic surgery.

[5]  Pérez Day Cm,et al.  [Coarctation of the aorta complicated by infectious endarteritis, mycotic aneurysm and rupture of the spleen]. , 1986 .

[6]  R. Pettigrew,et al.  Incidence of aneurysm formation after Dacron patch aortoplasty repair for coarctation of the aorta: long-term results and assessment utilizing magnetic resonance angiography with three-dimensional surface rendering. , 1995, Journal of the American College of Cardiology.

[7]  K. Bielenberg,et al.  Ascending aortic aneurysm associated with bicuspid and tricuspid aortic valve: involvement and clinical relevance of smooth muscle cell apoptosis and expression of cell death-initiating proteins. , 2003, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[8]  S. Daniels Repair of coarctation of the aorta and hypertension: does age matter , 2001, The Lancet.

[9]  R. Erbel,et al.  Detection of dissection of the aortic intima and media after angioplasty of coarctation of the aorta. An angiographic, computer tomographic, and echocardiographic comparative study. , 1990, Circulation.

[10]  E. Spooner,et al.  Management of pseudoaneurysm following patch grafting for coarctation of the aorta. , 1977, The Journal of thoracic and cardiovascular surgery.

[11]  E. Murphy,et al.  Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan's syndrome. , 1994, The New England journal of medicine.

[12]  J. Steinberger,et al.  Long-term follow-up of patients after coarctation of the aorta repair. , 2002, The American journal of cardiology.

[13]  R. Beekman,et al.  Rapid progression of aortic aneurysms after patch aortoplasty repair of coarctation of the aorta. , 1992, Journal of the American College of Cardiology.

[14]  J. A. Sobrino,et al.  Seudocoartación de aorta complicada con seudoaneurisma gigante , 2000 .

[15]  W. Williams,et al.  Synthetic patch angioplasty for repair of coarctation of the aorta: experience with aneurysm formation. , 1986, Circulation.

[16]  P. McLaughlin,et al.  Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up , 2001, Heart.

[17]  C. Tchervenkov,et al.  Aneurysm after subclavian flap angioplasty repair of coarctation of the aorta. , 1999, The Annals of thoracic surgery.

[18]  H. Baumgartner,et al.  Mechanisms underlying aortic dilatation in congenital aortic valve malformation. , 1999, Circulation.

[19]  P. Kilner,et al.  Repaired coarctation: a "cost-effective" approach to identify complications in adults. , 2000, Journal of the American College of Cardiology.

[20]  M. Prokop,et al.  High incidence of aneurysm formation following patch plasty repair of coarctation. , 1993, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[21]  A. Quyyumi,et al.  Insertion-deletion polymorphism of the ACE gene modulates reversibility of endothelial dysfunction with ACE inhibition. , 2000, Circulation.

[22]  D. Moodie Aortic dissection and coarctation. , 1990, Current opinion in cardiology.

[23]  M. Schlepper,et al.  Incidence and pathogenesis of late aneurysms after patch graft aortoplasty for coarctation. , 1986, The Journal of thoracic and cardiovascular surgery.

[24]  J. Bavaria,et al.  Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions. , 2000, Circulation.

[25]  S. A. Levine,et al.  Coarctation of the aorta; a review of 104 autopsied cases of the adult type, 2 years of age or older. , 1947, American heart journal.

[26]  C. Mavroudis,et al.  Risk Factors for Recoarctation and Results of Reoperation: A 40‐Year Review , 2000, Journal of cardiac surgery.

[27]  R. Hurwitz,et al.  Preoperative and postoperative "aneurysm" associated with coarctation of the aorta. , 1991, Journal of the American College of Cardiology.

[28]  A. B. Stewart,et al.  Coarctation of the aorta life and health 20-44 years after surgical repair. , 1993, British heart journal.

[29]  W. Guntheroth,et al.  Coarctation of the aorta: long-term follow-up and prediction of outcome after surgical correction. , 1990, Circulation.

[30]  H. Matsuda,et al.  Late true aneurysm after bypass grafting for long aortic coarctation. , 1996, The Annals of thoracic surgery.

[31]  J. Favre,et al.  Aortobronchial fistula: report of three cases and review of the literature. , 1994, Surgery.

[32]  G. Thiene,et al.  Aortic root dilatation in young men with normally functioning bicuspid aortic valves , 1999, Heart.

[33]  H. Schaff,et al.  Spectrum of reoperations after repair of aortic coarctation: importance of an individualized approach because of coexistent cardiovascular disease. , 2002, Mayo Clinic proceedings.

[34]  C. Warnes Bicuspid aortic valve and coarctation: two villains part of a diffuse problem , 2003, Heart.