@Article{chd.12488,
AUTHOR = {Maryanne Caruana, Victor Grech},
TITLE = {Long-term outcomes after aortic coarctation repair in Maltese patients: A population-based study},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {12},
YEAR = {2017},
NUMBER = {5},
PAGES = {588--595},
URL = {http://www.techscience.com/schd/v12n5/39193},
ISSN = {3071-1738},
ABSTRACT = {<b>Objectives:</b> 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.<br/>
<b>Design:</b> 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.<br/>
<b>Results:</b> 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 reinterventionfree 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).<br/>
<b>Conclusions:</b> 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.},
DOI = {10.1111/chd.12488}
}