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Heart Online First, published on March 25, 2015 as 10.1136/heartjnl-2014-307035 Congenital heart disease
ORIGINAL ARTICLE
Late outcomes in adults with coarctation of the aorta P Choudhary,1,2,3 C Canniffe,1,4 D J Jackson,1,2 D Tanous,1,3 K Walsh,4 D S Celermajer1,2 1
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 2 Discipline of Medicine, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia 3 Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia 4 Department of Cardiology, Mater Misericordiae Hospital, Dublin, Ireland Correspondence to Professor D S Celermajer, Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; [email protected]. gov.au Received 22 October 2014 Revised 24 February 2015 Accepted 25 February 2015
ABSTRACT Aims Previous cohort studies of patients with coarctation of the aorta (CoA) demonstrate reduced long-term survival. Improved surgical outcomes in children and evolution of adult congenital heart disease (ACHD) services have resulted in improved survival in patients with other CHDs. We hypothesise that for young adult patients with CoA long-term outcomes have improved in the contemporary era. Methods 151 patients (58% men) with simple CoA followed up at a tertiary ACHD service in Sydney, Australia, from 1993 to 2013 were included. We documented mortality and major morbidity such as the need for re-intervention for re-coarctation or aneurysms. Results 140 patients (mean age 35±15 years) underwent CoA repair at median age of 5 (IQR 0–10) years. Initial surgical strategy included end-to-end repair in 43, subclavian flap aortoplasty in 28 and patch aortoplasty in 31 patients (and was not documented in 28 cases). 6 patients had endovascular repair, 4 had interposition tube grafts and 11 were unrepaired. There were a total of seven deaths at a median age of 60 years. Actuarial survival was 98% at 40, 98% at 50 and 89% at 60 years of age. Re-coarctation occurred in 34% and descending aortic aneurysms were noted in 18%. Patients with end-to-end repair had lower rates of significant re-coarctation or descending aortic aneurysms ( p=0.026 and
Heart Online First, published on March 25, 2015 as 10.1136/heartjnl-2014-307035 Congenital heart disease
ORIGINAL ARTICLE
Late outcomes in adults with coarctation of the aorta P Choudhary,1,2,3 C Canniffe,1,4 D J Jackson,1,2 D Tanous,1,3 K Walsh,4 D S Celermajer1,2 1
Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 2 Discipline of Medicine, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia 3 Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia 4 Department of Cardiology, Mater Misericordiae Hospital, Dublin, Ireland Correspondence to Professor D S Celermajer, Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; [email protected]. gov.au Received 22 October 2014 Revised 24 February 2015 Accepted 25 February 2015
ABSTRACT Aims Previous cohort studies of patients with coarctation of the aorta (CoA) demonstrate reduced long-term survival. Improved surgical outcomes in children and evolution of adult congenital heart disease (ACHD) services have resulted in improved survival in patients with other CHDs. We hypothesise that for young adult patients with CoA long-term outcomes have improved in the contemporary era. Methods 151 patients (58% men) with simple CoA followed up at a tertiary ACHD service in Sydney, Australia, from 1993 to 2013 were included. We documented mortality and major morbidity such as the need for re-intervention for re-coarctation or aneurysms. Results 140 patients (mean age 35±15 years) underwent CoA repair at median age of 5 (IQR 0–10) years. Initial surgical strategy included end-to-end repair in 43, subclavian flap aortoplasty in 28 and patch aortoplasty in 31 patients (and was not documented in 28 cases). 6 patients had endovascular repair, 4 had interposition tube grafts and 11 were unrepaired. There were a total of seven deaths at a median age of 60 years. Actuarial survival was 98% at 40, 98% at 50 and 89% at 60 years of age. Re-coarctation occurred in 34% and descending aortic aneurysms were noted in 18%. Patients with end-to-end repair had lower rates of significant re-coarctation or descending aortic aneurysms ( p=0.026 and
