Risk factors for aortic complications in adults with coarctation of the aorta
Risk factors for aortic complications in adults with coarctation of the aorta
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DOI：
10.1016/j.jacc.2004.07.037
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发表时间：
2004-10-19
影响因子：
24
通讯作者：
Mesa, JM
中科院分区：
文献类型：
--
作者：
Oliver, JM;Gallego, P;Mesa, JM
结论：我们试图确定成人主动脉缩窄修复或未修复的患病率和主动脉壁并发症的易感条件。背景主动脉壁并发症可能发生在成人主动脉缩窄中，尽管在儿童期成功进行了手术修复。181例患者（I组）接受手术治疗，28例患者（II组）接受球囊血管成形术或支架植入术治疗。26例轻度主动脉缩窄的患者（III组）在诊断前没有进行过干预。结果37例患者（16%）中发现44例主动脉壁并发症。三组在总并发症（分别为15%、18%和15%）、升主动脉瘤（9%、11%和12%）或降主动脉瘤（所有三组均为4%）方面无差异。多变量分析未显示既往修复、修复类型、修复时年龄、残余多普勒压差或全身性高血压与主动脉并发症发生之间存在显著关系。只有衰老（风险比[RR] 1.4/10岁，95%置信区间[CI] 1.1 - 1.8，p = 0.002）和二叶式主动脉瓣（RR 3.2，95% CI 1.3至7.5，p = 0.005）的平均值与这些并发症显着相关。结论主动脉缩窄的成人中主动脉壁并发症很常见，超出了归因于主动脉缩窄的范围相关血流动力学紊乱或既往修复。唯一的独立危险因素似乎是高龄和二叶式主动脉瓣。(C)2004年，美国心脏病学会基金会。
OBJECTIVES We sought to determine the prevalence and predisposing condition for aortic wall complications in adults with either repaired or non-repaired coarctation of the aorta.BACKGROUND Aortic wall complications may develop in adults with coarctation of the aorta, despite successful surgical repair in childhood.METHODS A total of 235 adults with coarctation (mean age 27 +/- 13 years) were retrospectively reviewed. Treatment had been performed by surgery in 181 patients (group I) or by balloon angioplasty or stenting in 28 patients (group II). No previous intervention had been carried out in 26 patients with mild coarctation at diagnosis (group III).RESULTS Forty-four aortic wall complications were found in 37 patients (16%). There were no differences among the three groups with respect to total complications (15%, 18%, and 15%, respectively), ascending aortic aneurysms (9%, 11%, and 12%), or descending aortic aneurysms (4% in all three groups). Multivariate analysis did not show a significant relationship between previous repair, type of repair, age at repair, residual Doppler pressure gradient, or systemic hypertension and the occurrence of aortic complications. Only aging (risk ratio [RR] 1.4 per decade of age, 95% confidence interval [CI] 1.1 to 1.8, p = 0.002) and bicuspid aortic valve (RR 3.2, 95% CI 1.3 to 7.5, p = 0.005) were significantly related to these complications.CONCLUSIONS Aortic wall complications are frequent in adults with coarctation of the aorta beyond that attributable to associated hemodynamic derangement or previous repair. The only independent risk factors appear to be advanced age and bicuspid aortic valve. (C) 2004 by the American College of Cardiology Foundation.