CLINICAL STUDY: AORTIC ANEURISM
Predictors of aneurysmal formation after surgical correction of aortic coarctation
Yskert von Kodolitsch, MD*,*,
Muhammet A. Aydin, MD*,
Dietmar H. Koschyk, MD*,
Roger Loose, MD ,
Ilka Schalwat, MD*,
Matthias Karck, MD ,
Jochen Cremer, MD,
Axel Haverich, MD,
J.ürgen Berger, PhD ,
Thomas Meinertz, MD* and
Christoph A. Nienaber, MD, FACC*
* Department of Internal Medicine, Division of Cardiology, Hamburg, Germany
Institute of Mathematics and Computer Science in Medicine, University Hospital Eppendorf, Hamburg, Germany
Department of Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
Department of Cardiovascular Surgery, Christian-Albrechts-University, Kiel, Germany
Manuscript received June 11, 2001;
revised manuscript received October 31, 2001,
accepted November 16, 2001.
* Reprint requests and correspondence: Dr. Yskert von Kodolitsch, Department of Internal Medicine, Division of Cardiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
kodolitsch{at}uke.uni-hamburg.de
OBJECTIVES: We sought to identify the predictors of aneurysmal formation after surgical correction of aortic coarctation.
BACKGROUND: In 9% of patients, aneurysms develop late after corrective surgery of coarctation of the aorta, with a 36% mortality rate if left untreated. However, the predictors of postsurgical aneurysmal formation are unknown.
METHODS: Of 25 aortic aneurysms requiring corrective surgery 152 ± 78 months after the initial coarctation repair, 8 were located in the ascending aorta (type A) and 17 at the site of previous repair (local type). Seventy-four patients without progression of the aortic diameter within 189 ± 71 months after coarctation repair were used for categorical data analysis in an attempt to identify the predictors of postsurgical aneurysmal formation.
RESULTS: Advanced age at coarctation repair (p = 0.004) and patch graft technique (p < 0.0005) independently predicted local aneurysmal formation. Type A aneurysm was univariately associated with the presence of a bicuspid aortic valve (p = 0.02), advanced age at coarctation repair (p = 0.044) and a high preoperative peak systolic pressure gradient of 74 ± 21 mm Hg (p = 0.041). Conversely, multivariate analysis confirmed only the presence of a bicuspid aortic valve (p = 0.015) as an independent predictor of type A aneurysm. Receiver operating characteristic curve analysis revealed that 72% of patients with a postsurgical aneurysm had an operation at age 13.5 years or more, whereas 69% with no postsurgical aneurysm had an operation at a younger age.
CONCLUSIONS: Use of the patch graft technique and late correction of coarctation can predict aneurysmal formation at the site of coarctation repair, although patients with a bicuspid aortic valve may be at risk for an aneurysm developing in the ascending aorta, particularly after late repair of aortic coarctation with high preoperative pressure gradients.
|
Abbreviations and Acronyms
| | BP | | blood pressure | | CBAV | | congenitally bicuspid aortic valve | | ROC | | receiver operating characteristic |
|
This article has been cited by other articles:
|
|
|
|
 
L. Botta, V. Russo, G. Oppido, M. Rosati, F. Massi, L. Lovato, R. Di Bartolomeo, and R. Fattori
Role of endovascular repair in the management of late pseudo-aneurysms following open surgery for aortic coarctation
Eur. J. Cardiothorac. Surg.,
October 1, 2009;
36(4):
670 - 674.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Charokopos, P. Artemiou, P. Antonitsis, E. Rouska, and I. Stinios
Repair of Aortic Coarctation in an Adult by Direct Aortoplasty
Asian Cardiovasc Thorac Ann,
October 1, 2009;
17(5):
516 - 518.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Troost, M. Gewillig, W. Daenen, B. Meyns, J. Bogaert, K. Van Deyk, and W. Budts
Behaviour of polyester grafts in adult patients with repaired coarctation of the aorta
Eur. Heart J.,
May 1, 2009;
30(9):
1136 - 1141.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. R. Nair, H. Vasu, A. Jacob, and B. V. Velayudhan
Aortic root replacement in a patient with previous multiple surgeries for coarctation of aorta.
Ann. Thorac. Surg.,
March 1, 2009;
87(3):
930 - 933.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Nienaber, I. Akin, R. Erbel, and A. Haverich
CHAPTER 31 Diseases of the Aorta and Trauma to the Aorta and the Heart
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Frydrychowicz, A. Berger, M. F. Russe, A. F. Stalder, A. Harloff, S. Dittrich, J. Hennig, M. Langer, and M. Markl
Time-resolved magnetic resonance angiography and flow-sensitive 4-dimensional magnetic resonance imaging at 3 Tesla for blood flow and wall shear stress analysis.
J. Thorac. Cardiovasc. Surg.,
August 1, 2008;
136(2):
400 - 407.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Vijayalakshmi, A. Griffiths, A. Hasan, and J. O'Sullivan
Late hazards after repair of coarctation of the aorta
BMJ,
April 5, 2008;
336(7647):
772 - 773.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Kpodonu, G. H. Wheatley III, J. P. Williams, J. A. Rodriguez-Lopez, V. G. Ramaiah, and E. B. Diethrich
A Novel Approach for the Endovascular Repair of the Small Thoracic Aorta: Customizing Off-the-Shelf Endoluminal Grafts to Treat a Post-Coarctation Pseudoaneurysm
Ann. Thorac. Surg.,
March 1, 2008;
85(3):
1115 - 1117.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Bakker, C. Visser, A. Guderian, J. Haenen, and R. Breedveld
Emergency operation on the dissected ascending aorta of an adolescent with aortic coarctation
Perfusion,
September 1, 2007;
22(5):
365 - 367.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. Goto, Y. Tsutsumi, T. Kawai, and H. Ohhashi
Total arch replacement of late aneurysm after bypass grafting for coarctation of the aorta
Eur. J. Cardiothorac. Surg.,
July 1, 2007;
32(1):
176 - 177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Marcheix, Y. Lamarche, P. Perrault, R. Cartier, D. Bouchard, M. Carrier, L. P. Perrault, and P. Demers
Endovascular management of pseudo-aneurysms after previous surgical repair of congenital aortic coarctation
Eur. J. Cardiothorac. Surg.,
June 1, 2007;
31(6):
1004 - 1007.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y.-Q. Lai, Q.-W. Zhou, H. Wei, C. Zhang, and Z.-G. Zhang
Intrapulmonary Channel for One-Stage Correction of Aortic Arch Obstruction
Asian Cardiovasc Thorac Ann,
October 1, 2006;
14(5):
402 - 406.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A E Warren, M L Boyd, C O'Connell, and L Dodds
Dilatation of the ascending aorta in paediatric patients with bicuspid aortic valve: frequency, rate of progression and risk factors
Heart,
October 1, 2006;
92(10):
1496 - 1500.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. T. Tsai, C. A. Nienaber, and K. A. Eagle
Acute Aortic Syndromes
Circulation,
December 13, 2005;
112(24):
3802 - 3813.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Rosenthal
Coarctation of the aorta from fetus to adult: curable condition or life long disease process?
Heart,
November 1, 2005;
91(11):
1495 - 1502.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gawenda, M. Aleksic, J. Heckenkamp, K. Kruger, and J. Brunkwall
Endovascular repair of aneurysm after previous surgical coarctation repair
J. Thorac. Cardiovasc. Surg.,
October 1, 2005;
130(4):
1039 - 1043.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Carr, J. J. Amato, and R. S.D. Higgins
Long-Term Results of Surgical Coarctectomy in the Adolescent and Young Adult With 18-Year Follow-Up
Ann. Thorac. Surg.,
June 1, 2005;
79(6):
1950 - 1956.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Oliver, P. Gallego, A. Gonzalez, A. Aroca, M. Bret, and J. M. Mesa
Risk factors for aortic complications in adults with coarctation of the aorta
J. Am. Coll. Cardiol.,
October 19, 2004;
44(8):
1641 - 1647.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. W. J. Vriend, B. J. M. Mulder, P. H. Schoof, and M. G. Hazekamp
Median sternotomy for reoperation of the distal aortic arch in postcoarctectomy patients
Ann. Thorac. Surg.,
September 1, 2004;
78(3):
e58 - e60.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Nienaber, R. Fattori, R. H. Mehta, B. M. Richartz, A. Evangelista, M. Petzsch, J. V. Cooper, J. L. Januzzi, H. Ince, U. Sechtem, et al.
Gender-Related Differences in Acute Aortic Dissection
Circulation,
June 22, 2004;
109(24):
3014 - 3021.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E. Fawzy, M. Awad, W. Hassan, Y. Al Kadhi, M. Shoukri, and F. Fadley
Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults
J. Am. Coll. Cardiol.,
March 17, 2004;
43(6):
1062 - 1067.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Januzzi, E. M. Isselbacher, R. Fattori, J. V. Cooper, D. E. Smith, J. Fang, K. A. Eagle, R. H. Mehta, C. A. Nienaber, and L. A. Pape
Characterizing the young patient with aortic dissection: results from the international registry of aortic dissection (IRAD)
J. Am. Coll. Cardiol.,
February 18, 2004;
43(4):
665 - 669.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Ince, M. Petzsch, T. Rehders, S. Kische, T. Korber, F. Weber, and C. A. Nienaber
Percutaneous Endovascular Repair of Aneurysm After Previous Coarctation Surgery
Circulation,
December 16, 2003;
108(24):
2967 - 2970.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. A. Nienaber and K. A. Eagle
Aortic Dissection: New Frontiers in Diagnosis and Management: Part I: From Etiology to Diagnostic Strategies
Circulation,
August 5, 2003;
108(5):
628 - 635.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Ashizawa, H. Tasaki, R. Shibata, Y. Koide, S. Seto, S. Yamachika, S. Hazama, K. Eishi, and K. Yano
A rare case of aortic tube graft occlusion 35 years after coarctectomy
Ann. Thorac. Surg.,
June 1, 2003;
75(6):
1961 - 1963.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
