Key result
Adult coarctation repair leaves ~73% with persistent hypertension linked to increased cardiovascular events.
Why the study?
The study was conducted to describe procedural outcomes, hemodynamic improvement, regression of left ventricular mass hypertrophy, and cardiovascular outcomes after coarctation of aorta repair.
Does primary repair of native coarctation of the aorta in adults improve hemodynamics and long-term clinical outcomes?
Cohort (n=172)
No
Does primary repair of native coarctation of the aorta in adults improve hemodynamics and long-term clinical outcomes?
Answers are grounded in this paper and cite their sources.
Although anatomical correction of native aortic coarctation in adulthood is hemodynamically successful, the high prevalence of persistent hypertension necessitates aggressive ongoing medical management to prevent adverse cardiovascular remodeling and events.
The purpose of this study was to describe procedural outcomes, hemodynamic improvement, regression of left ventricular (LV) mass hypertrophy, and cardiovascular. The primary outcomes were procedural complications, reinterventions, and hemodynamic improvement after coarctation of aorta (COA) repair. The secondary outcomes were improvement in the severity of hypertension, regression of LV mass index, and incidence of cardiovascular events (atrial fibrillation, ventricular tachycardia, heart failure hospitalization, and cardiovascular death) after COA repair. Secondary outcomes were assessed only in patients with isolated COA who had clinical and imaging follow-up at 1 year and 3 years postintervention. Of 172 patients that underwent COA repair (surgical 161; transcatheter 11), there were no procedural deaths, and all patients had residual COA gradient <20 mm Hg. Of 128 patients that met criteria for secondary outcomes assessment, 39 (36%) had a reduction in the intensity of antihypertension therapy, and cardiovascular events occurred in 16 (13%) patients. There was no significant reduction in the overall prevalence of hypertension (stage 1 and stage 2) over time (78% versus 70% versus 73%, P =0.4 at baseline, 1 year and 3 years). Postintervention hypertension (both stage 1 and 2) were independent risk factors for suboptimal left ventricular mass index regression and cardiovascular events. Persistent hypertension was common after repair of native COA in adults and was associated with suboptimal left ventricular mass index regression and cardiovascular events. These results suggest that optimal blood pressure control with medical therapy after COA repair may result in improved clinical outcomes.
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Egbe et al. (2021) conducted a cohort in Native coarctation of the aorta (n=172). Coarctation of aorta repair (surgical or transcatheter) was evaluated on Procedural complications, reinterventions, and hemodynamic improvement after COA repair. Primary repair of native coarctation of the aorta in adults was safe and hemodynamically effective, but hypertension persisted in 73% at 3 years and was independently associated with suboptimal left ventricular mass regression and increased cardiovascular events.
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