Long-term outcomes after aortic coarctation repair in Maltese patients : a population-based study

Abstract

Objectives: To investigate survival and freedom from reintervention after aortic coarctation repair in Maltese patients and to compare cardiovascular mortality in coarctation repair survivors with that in the general population. Design: All 72 aortic coarctation patients with any type of repair, born by end-1997 and logged in the local database were included. Trends in timing and type of repair were determined by comparing patients born before and after 1985. Kaplan-Meier analyses of survival and reintervention-free survival were performed on the 59 repair survivors with complete follow-up data (mean follow-up 26.13 ± 9.62 (range 1.05–44.55 years). Cardiovascular mortality in repair survivors was compared with that in 438 age- and sex-matched general Maltese controls. Results: Patients born after 1985 underwent repair at a younger age (median age 0.18 vs 13.96 years; P < .001), with less patch aortoplasties in favor of end-to-end anastomosis or transcatheter stenting. Among the 59 long-term follow-up patients, there were 7 cardiovascular deaths and 10 patients needed reintervention. Estimated mean survival was 40.33 years (95% CI 37.71, 42.95) with a survival rate of 67.5% at 40 years from repair. Estimated mean reintervention-free survival was 38.13 years (95% CI 34.52, 41.75) with freedom from reintervention rate of 77% at 30 years. Patients repaired aged <10 years required earlier reintervention (estimated mean reintervention-free survival 35.12 years (95% CI 29.54, 40.71) vs 40.80 years (95% CI 37.16, 44.37); P = .04). There was an excess of cardiovascular deaths among repaired coarctation subjects compared to the general population (11.9% vs 1.4%; P < .001) and survival in coarctation patients was significantly lower (67.90 years (95% CI 60.28, 75.52) vs 85.78 years (95% CI 83.12, 88.44); P < .001). Conclusions: Despite earlier diagnosis and repair, contemporary coarctation repair survivors remain at increased risk of cardiovascular death. An important proportion require repair site reintervention. Specialist follow-up and aggressive cardiovascular risk factor management are mandatory to improve long-term outcomes.