Long-Term Outcome after Repair of Coarctation of the Aorta with Focus on Hypertension

Background: The coarctation of the aorta (CoA) is a common congenital defect (~0.5 per 1,000 live births). According to the type and symptoms, treatment may be indicated early after birth. Although restenosis and aneurysms are the most feared problems after repair, hypertension may remain a problem or even develop new.

Method: Retrospective study of 132 consecutive patients (female: 51, male: 81) who underwent isolated coarctation repair in a 20-year period from 1995 to 2014. Concomitant cardiac procedures were an exclusion criterion. Follow-up was complete in 110 out of 130 patients with a mean of 9.5 ± 6.2 years (1.041 patient-years).

Results: Mean age at surgery was 3.1 ± 9.1 years (range: 1 day to 61 years). Most patients were infants (<1 year of age; n = 99). Additional cardiac and/or vascular findings were present in almost cases. Six patients were on antihypertensive medication preoperatively. The most often applied repair techniques were resection with extended end-to-end anastomosis (80%), followed by resection and limited end-to-end anastomosis (18%). Early mortality rate was 1.5% (n = 2). During follow-up, 12 patients underwent 17 redo CoA procedures; balloon dilatation (9 procedures), stent implantation (3 procedures), and redo surgery (5 procedures). Additionally, 20 patients underwent cardiac and other vascular procedures.

While 54 patients (58%) had normal blood pressure at follow-up, 39 patients (42%) had hypertension, and most of hypertensive patients were on medication (n = 23). The need for antihypertensive medication increased after the first postoperative decade.

Conclusion: Most patients with CoA underwent surgery in infancy, mainly resection with extended end-to-end anastomosis. The long-term results are good with low redo rates. However, more than 40% of the patients developed hypertension in long-term follow-up and more than half of them are on anti-hypertensive medication. Therefore, close follow-up visits are essential.

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Artikel online veröffentlicht:
28. Januar 2023