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J Am Coll Cardiol, 2002; 39:617-624 © 2002 by the American College of Cardiology Foundation |
* 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.
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