Neurological complications in aortic coarctation: Results of a Nationwide analysis based on 11,907 patients

Int J Cardiol. 2021 Jan 1;322:114-120. doi: 10.1016/j.ijcard.2020.08.041. Epub 2020 Aug 14.

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.

Keywords: Aortic coarctation; Congenital heart disease; Mortality; Neurological complications; Stroke; Subarachnoid bleeding.

MeSH terms

  • Adult
  • Aortic Coarctation* / diagnostic imaging
  • Aortic Coarctation* / epidemiology
  • Aortic Coarctation* / surgery
  • Blood Pressure
  • England / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension*
  • Male
  • Retrospective Studies
  • Risk Factors