Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation

Author:

Meijs Timion A.1ORCID,Minderhoud Savine C. S.2,Muller Steven A.1ORCID,de Winter Robbert J.3,Mulder Barbara J. M.3,van Melle Joost P.4,Hoendermis Elke S.4,van Dijk Arie P. J.5,Zuithoff Nicolaas P. A.6,Krings Gregor J.7ORCID,Doevendans Pieter A.189ORCID,Witsenburg Maarten2ORCID,Roos‐Hesselink Jolien W.2ORCID,van den Bosch Annemien E.2,Bouma Berto J.3ORCID,Voskuil Michiel1

Affiliation:

1. Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands

2. Department of Cardiology Erasmus Medical Center Rotterdam The Netherlands

3. Department of Cardiology Amsterdam UMC, Location Academic Medical Center Amsterdam The Netherlands

4. Department of Cardiology University Medical Center Groningen Groningen The Netherlands

5. Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands

6. Department of Epidemiology and Biostatistics Julius Center for Health Sciences and Primary Care Utrecht The Netherlands

7. Department of Pediatric Cardiology Wilhelmina Children’s Hospital Utrecht The Netherlands

8. Department of Cardiology Central Military Hospital Utrecht The Netherlands

9. Netherlands Heart Institute Utrecht The Netherlands

Abstract

Background The long‐term burden of cardiovascular disease after repair of coarctation of the aorta (CoA) has not been elucidated. We aimed to determine the incidence of and risk factors for cardiovascular events in adult patients with repaired CoA. Additionally, mortality rates were compared between adults with repaired CoA and the general population. Methods and Results Using the Dutch Congenital Corvitia (CONCOR) registry, patients aged ≥16 years with previous surgical or transcatheter CoA repair from 5 tertiary referral centers were included. Cardiovascular events were recorded, comprising coronary artery disease, stroke/transient ischemic attack, aortic complications, arrhythmias, heart failure hospitalizations, endocarditis, and cardiovascular death. In total, 920 patients (median age, 24 years [range 16–74 years]) were included. After a mean follow‐up of 9.3±5.1 years, 191 patients (21%) experienced at least 1 cardiovascular event. A total of 270 cardiovascular events occurred, of which aortic complications and arrhythmias were most frequent. Older age at initial CoA repair (hazard ratio [HR], 1.017; 95% CI, 1.000–1.033 [ P =0.048]) and elevated left ventricular mass index (HR, 1.009; 95% CI, 1.005–1.013 [ P <0.001]) were independently associated with an increased risk of cardiovascular events. The mortality rate was 3.3 times higher than expected based on an age‐ and sex‐matched cohort from the Dutch general population (standardized mortality ratio, 3.3; 95% CI, 2.3–4.4 [ P <0.001]). Conclusions This large, prospective cohort of adults with repaired CoA showed a high burden of cardiovascular events, particularly aortic complications and arrhythmias, during long‐term follow‐up. Older age at initial CoA repair and elevated left ventricular mass index were independent risk factors for the occurrence of cardiovascular events. Mortality was 3.3‐fold higher compared with the general population. These results advocate stringent follow‐up after CoA repair and emphasize the need for improved preventive strategies.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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