Neurological complications in aortic coarctation: Results of a Nationwide analysis based on 11, 907 patients. (1st January 2021)

• Record Type: Journal Article
• Authors: Trenk, Lukas; Lammers, Astrid Elisabeth; Radke, Robert; Baumgartner, Helmut; Wort, Stephen J.; Gatzoulis, Michael A.; Diller, Gerhard-Paul; Kempny, Aleksander
• Is Part Of: International journal of cardiology. Volume 322(2021)
• Page Start: 114
• Page End: 120
• Publication Date: 2021-01-01
• Subjects: Congenital heart disease -- Aortic coarctation -- Neurological complications -- Stroke -- Subarachnoid bleeding -- Mortality; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.08.041
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Patients with coarctation of the aorta (CoA) are at increased risk of periprocedural and late neurological complications. Based on a nationwide inpatient dataset, we assessed the prevalence and risk factors for neurological complications in this cohort. Method and Results: We included all CoA patients hospitalized in England between 1997 and 2015. The risk for procedural complications, subarachnoid bleeding and ischemic stroke were quantified, and risk factors investigated. Overall, 11, 907 patients (60% male) with CoA were identified. The median age at first presentation was 0.6 years with a median follow-up period of 14.4 years. Throughout the study period, 8456 surgical or interventional procedures were performed in 6796 patients. The neurological complication rate for primary surgical or interventional repair in patients born after 1997 was 0.05% and 0.2%, respectively. During a total follow-up period of 146, 295 patient-years, late neurological complications such as subarachnoid bleeding and cerebral infarction occurred in 225 patients (0.15%/patient-year). The median age for subarachnoid bleeding was 29 years and 57 years for ischemic stroke. While, arterial hypertension ( p = .0014), current smoking ( p = .02), dyslipidaemia ( p = .007) and diabetes ( p = .037) were significantly related to the risk of ischemic stroke, only arterial hypertension emerged as significant risk factor for subarachnoid bleeding. Conclusions: Neurological complication during primary CoA repair are extremely rare in the current era. In contrast, many CoA patients are afflicted by late complications such as subarachnoid bleeding and ischemic stroke at a relatively young age, emphasizing the need for meticulous and pro-active blood pressure control and reduction of cardiovascular risk factors. Highlights: Procedural neurological complications in CoA patients occur at an extremely low rate CoA patients are still at significantly increased risk of developing SAB or ischemic stroke despite previous correction Main drivers of ischemic neurological complications are the usual cardiovascular risk factors (e.g. arterial hypertension, diabetes, smoking) SAB mainly predicted by persistent arterial hypertension Need for life-long, pro-active blood pressure control and risk factor modification in all CoA patients