Surgical repair of coarctation of the aorta: up to 40 years of follow-up
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Surgical repair of coarctation of the aorta : up to 40 years of follow-up. / Høimyr, Hilde; Christensen, Thomas D; Emmertsen, Kristian; Johnsen, Søren P; Riis, Anders; Hansen, Ole Kromann; Hjortdal, Vibeke E.
I: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Bind 30, Nr. 6, 12.2006, s. 910-6.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Surgical repair of coarctation of the aorta
T2 - up to 40 years of follow-up
AU - Høimyr, Hilde
AU - Christensen, Thomas D
AU - Emmertsen, Kristian
AU - Johnsen, Søren P
AU - Riis, Anders
AU - Hansen, Ole Kromann
AU - Hjortdal, Vibeke E
PY - 2006/12
Y1 - 2006/12
N2 - OBJECTIVE: Coarctation of the aorta (CoA) was previously considered cured after surgical repair. Evidence for excess mortality and late morbidity has later accumulated, although studies with long-term follow-up remain sparse. The aim was to identify patients operated for CoA at Aarhus University Hospital, Denmark between 1965 and 1985 and to assess surgical and late mortality and cardiovascular morbidity in this cohort and possible predictors for an adverse outcome.METHODS: Two hundred and twenty nine patients were identified. Baseline characteristics and morbidity and mortality data were obtained from medical records, registries and databases and analysed by Kaplan-Meier graphs and multivariate Cox regression analyses.RESULTS: There were 14 (6%) surgical deaths. The survival in patients who were alive 30 days postoperatively was 95% 10 years after surgery, and 91%, 83% and 69% after 20, 30 and 40 years, respectively. The mortality rate ratio for all long-term survivors compared with an age- and sex-matched reference group was 4.3 (2.9-6.4). In those with no cardiovascular comorbidity at the time of repair, it was 3.4 (1.8-6.4). The causes of late deaths were cardiovascular in 63%. CoA repair in the early decade, age below 1 year at repair and high level of comorbidity were predictors for late mortality. Twenty five percent of current survivors were on antihypertensive medication and further cardiovascular morbidity had occurred in 46 (26%), including cardiovascular surgery and catheter interventions in 35 (19%). Freedom from death, reintervention and cardiovascular complications other than hypertension was 60% 30 years after surgery in the entire study population.CONCLUSIONS: Repaired CoA is associated with excess cardiovascular mortality and morbidity and often in need of reintervention. These patients, therefore, need careful follow-up.
AB - OBJECTIVE: Coarctation of the aorta (CoA) was previously considered cured after surgical repair. Evidence for excess mortality and late morbidity has later accumulated, although studies with long-term follow-up remain sparse. The aim was to identify patients operated for CoA at Aarhus University Hospital, Denmark between 1965 and 1985 and to assess surgical and late mortality and cardiovascular morbidity in this cohort and possible predictors for an adverse outcome.METHODS: Two hundred and twenty nine patients were identified. Baseline characteristics and morbidity and mortality data were obtained from medical records, registries and databases and analysed by Kaplan-Meier graphs and multivariate Cox regression analyses.RESULTS: There were 14 (6%) surgical deaths. The survival in patients who were alive 30 days postoperatively was 95% 10 years after surgery, and 91%, 83% and 69% after 20, 30 and 40 years, respectively. The mortality rate ratio for all long-term survivors compared with an age- and sex-matched reference group was 4.3 (2.9-6.4). In those with no cardiovascular comorbidity at the time of repair, it was 3.4 (1.8-6.4). The causes of late deaths were cardiovascular in 63%. CoA repair in the early decade, age below 1 year at repair and high level of comorbidity were predictors for late mortality. Twenty five percent of current survivors were on antihypertensive medication and further cardiovascular morbidity had occurred in 46 (26%), including cardiovascular surgery and catheter interventions in 35 (19%). Freedom from death, reintervention and cardiovascular complications other than hypertension was 60% 30 years after surgery in the entire study population.CONCLUSIONS: Repaired CoA is associated with excess cardiovascular mortality and morbidity and often in need of reintervention. These patients, therefore, need careful follow-up.
KW - Adolescent
KW - Adult
KW - Age Factors
KW - Antihypertensive Agents/administration & dosage
KW - Aortic Coarctation/mortality
KW - Cause of Death
KW - Child
KW - Child, Preschool
KW - Denmark/epidemiology
KW - Drug Administration Schedule
KW - Epidemiologic Methods
KW - Female
KW - Heart Defects, Congenital/surgery
KW - Humans
KW - Infant
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Treatment Outcome
U2 - 10.1016/j.ejcts.2006.09.016
DO - 10.1016/j.ejcts.2006.09.016
M3 - Journal article
C2 - 17056267
VL - 30
SP - 910
EP - 916
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 6
ER -
ID: 242780800