Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, UK.
Adult Congenital Heart Disease Programme, Royal Brompton Hospital, London, UK; Competence Network for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
Int J Cardiol. 2021 Jan 1;322:114-120. doi: 10.1016/j.ijcard.2020.08.041. Epub 2020 Aug 14.
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.
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.
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.
主动脉缩窄（CoA）患者围手术期和晚期神经并发症的风险增加。基于全国住院患者数据集，我们评估了该队列中神经并发症的患病率和危险因素。
我们纳入了 1997 年至 2015 年期间在英国住院的所有 CoA 患者。量化了手术并发症、蛛网膜下腔出血和缺血性卒中的风险，并探讨了危险因素。共有 11907 例 CoA 患者（60%为男性）纳入研究。首次就诊的中位年龄为 0.6 岁，中位随访时间为 14.4 年。在整个研究期间，在 6796 例患者中进行了 8456 例手术或介入治疗。1997 年后出生的患者初次手术或介入修复的神经并发症发生率分别为 0.05%和 0.2%。在 146295 患者年的总随访期间，225 例患者发生晚期神经并发症，如蛛网膜下腔出血和脑梗死（0.15%/患者年）。蛛网膜下腔出血的中位年龄为 29 岁，缺血性卒中为 57 岁。虽然动脉高血压（p=0.0014）、当前吸烟（p=0.02）、血脂异常（p=0.007）和糖尿病（p=0.037）与缺血性卒中的风险显著相关，但只有动脉高血压是蛛网膜下腔出血的显著危险因素。
在当前时代，CoA 初次修复期间发生神经并发症的情况极为罕见。相反，许多 CoA 患者在相对年轻的年龄就患有晚期并发症，如蛛网膜下腔出血和缺血性卒中，这强调了需要精细和积极的血压控制以及降低心血管危险因素。
