Abstract 17275: Improved Survival in the Current Era in Adults With Coarctation of the Aorta
Introduction: Previous studies have reported a median age at death of 38 years in patients with repaired coarctation of the aorta (CoA). We hypothesized that this has improved in the contemporary era.
Methods: We evaluated outcomes in adult patients (seen at least once when aged >16 years) with simple coarctation from a tertiary referral center. Patients with bicuspid aortic valves, ductus arteriosus or ventricular septal defect not requiring surgical repair were included.
Results: 150 patients (57% male) with aged 39+/-15 years were included. Age at coarctation surgery was 9+/-15 years with end-to-end repair in 37, subclavian flap in 24 and patch aortoplasty in 27 patients. 6 had endovascular repair, 14 were unrepaired and repair type was not known in 42. Follow-up period was 35+/-16 years. 95 (63%) had bicuspid aortic valves. Five deaths occurred; 2 with ascending aortic dissection (a 31 year old with Turner’s syndrome and a male with un-repaired CoA), one with subarachnoid hemorrhage (24 year old), and two with sudden cardiac death (a 56 year old male with coronary disease and a 62 year old lady, cause unknown). Actuarial survival was 99% at 40 years, 98% at 50 and 92% to 60 years.
Recoarctation occurred in 29%, with 12% requiring surgical repair. Aortic aneurysms (ascending and descending) occurred in 15% requiring surgical repair in 11%. CoA surgical repair strategy did not influence mortality or incidence of re-coarctation. Patch aortoplasty was significantly associated with a higher risk of local aneurysm formation (p<0.001).
Conclusion: In the contemporary era, long-term survival is good up to age 60 years, in those surviving childhood. Long-term morbidity is common, related largely to aortic complications.
- © 2013 by American Heart Association, Inc.