Predictors of aneurysmal formation after surgical correction of aortic coarctation.
OBJECTIVE
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.
von Kodolitsch
Yskert
Y
Department of Internal Medicine, Division of Cardiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. kodolitsch@uke.uni-hamburg.de
Aydin
Muhammet A
MA
Koschyk
Dietmar H
DH
Loose
Roger
R
Schalwat
Ilka
I
Karck
Matthias
M
Cremer
Jochen
J
Haverich
Axel
A
Berger
Jürgen
J
Meinertz
Thomas
T
Nienaber
Christoph A
CA
D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000002:abnormalities / Q000601:surgery; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000601:surgery; D001014:Aortic Aneurysm / Q000209:etiology*; D001017:Aortic Coarctation / Q000150:complications* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors