Risk Factors for Late Adverse Events after Primary Surgical Repair of Isolated Aortic Coarctation

Background: In this long-term retrospective single institution study on patients with simple coarctation operated <18 years via left lateral thoracotomy, we examined the role of associated cardiovascular malformations, gender, coarctation pressure gradient, kind of surgical therapy, age, and surgical era on the endpoints death, restenosis, aneurysm formation, hypertension development, and any of these events.

Methods: 359 patients <18 years (69.9% males) at surgery (mean 0.21 years) without complex concomitant malformations (other than PDA, ASD, VSD) operated between 1972 and 2020 were included. Kaplan-Meier freedom-from-event curves, Cox regressions (pulmonary artery banding [PAB] was not included for low case/event numbers, but evaluated separately), and competing risk analyses were calculated with R, R commander, and EZR.

Results: Follow-up time was of 49.7 years (mean 22.7, median 25.1). 210 patients had their last visit >5 years ago. Age at operation: 42 (11.7%) were operated <1 week; 99 (27.6%) 1 week to 1 month; 92 (25.6%) 1 month to 1 year; 23 (6.4%) 1 to 3 years; 45 (12.3%) <10 years , and 58 (16.6%) <18 years. Surgical therapy: 52.4% had end-to-end anastomoses, 24.5% PTFE patches, 4.5% Dacron patches, 3.9% end-to-side anastomoses. 11 patients (3.1%) had previous PAB. 38 patients (10.5%) died during the entire follow-up period. The mean time between primary surgery and death was 15.61 years (median = 12.70 years; IQR = 30.77 years). A total of 72 (20%) patients developed postoperative re-stenosis requiring treatment. Of these, 28 (26.9%) patients were treated surgically and 76 (73.10%) were treated interventionally. 14 (3.9%) patients developed postoperative aneurysm of the aorta with 17 (89.50%) surgical and 2 (10.5%) interventional treatments. A total of 125 (34.80%) patients were receiving antihypertensive medication or were suffering from hypertension at any time during follow-up. Cox regression analyses showed following statistically significant factors: the patients after Dacron or PTFE patch repair had increased risk for aortic aneurysms. Concomitant aortic valve anomalies, but not older age at primary operation, predisposed to earlier occurrence of hypertension. No endpoint was affected by surgical era.

Conclusion: Complications can occur even late after primary aortic coarctation repair, so regular exams must be performed. Cox regression showed no statistically significant effect of era or age of primary coarctation correction. Patients after primary surgical patch aortoplasty have increased risk for aneurysm formation.

Publication History

Article published online:
11 February 2025