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Congenital heart disease
Original research
Late complication rates after aortic coarctation repair in patients with or without a bicuspid aortic valve
  1. Michelle S Lim1,2,
  2. Rachael Cordina1,2,
  3. Irina Kotchetkova2,
  4. David S Celermajer1,2
  1. 1 Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
  2. 2 Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  1. Correspondence to Dr Michelle S Lim, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia; michelle.lim{at}sydney.edu.au

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.

  • aortic coarctation
  • aortic aneurysm
  • congenital abnormalities

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/heartjnl-2021-319969

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors ML, RC and DSC were involved in study design. ML, with assistance from IK, performed data acquisition and analysis. All authors were involved in data interpretation and drafting and revision of the manuscript. All authors attest to the accuracy and integrity of the work being presented and approve of the final version being submitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.