Surgical treatment of atypical aortic coarctation complicating Takayasu's arteritis--experience with 33 cases over 44 years.
OBJECTIVE
This study was conducted to evaluate the long-term outcomes of surgical treatment for atypical aortic coarctation due to Takayasu's arteritis and to elucidate the factors that affected outcome.


METHODS
The outcomes of surgical treatment for atypical aortic coarctation complicating Takayasu's arteritis in 33 consecutive patients over the previous 44 years at our institution were reviewed retrospectively. Preoperatively, 29 patients had coarctation proximal to the renal arteries and hypertension in the upper half of the body. Four hospital deaths occurred, and the remaining 29 patients were followed from 0.5 to 42.0 years (median, 17.9 years). The impacts of several risk factors on survival as well as cardiac and vascular events were analyzed.


RESULTS
Among 27 initial survivors who had hypertension preoperatively, 15 did not show normalization of blood pressure. The overall cumulative survival and event-free survival rate at 20 years were 62.3% and 58.4%, respectively. Serious long-term complications were anastomotic aneurysms, congestive heart failure, cerebrovascular accident, graft deterioration, abdominal aortic aneurysms, and renal failure. Among several risk factors analyzed, only the presence of postoperative hypertension had an effect on event-free survival.


CONCLUSIONS
The long-term survival after surgery for atypical aortic coarctation was satisfactory. However, our study showed that complications associated with cardiovascular system or the operation could occur at any time after surgery; thus, life-long follow-up is mandatory. Further, the absence of normalization of blood pressure after surgery was a poor prognostic factor. Our results demonstrate the need for an intimate preoperative evaluation of renal and carotid artery lesions, which often coexist and may also cause secondary hypertension, to fully manage hypertension by surgery.
Taketani
Tsuyoshi
T
Department of Cardiothoracic Surgery, and Division of Vascular Surgery, Graduate School of Medicine, The University of Tokyo, Japan. ttaketa-tky@umin.ac.jp <ttaketa-tky@umin.ac.jp>
Miyata
Tetsuro
T
Morota
Tetsuro
T
Takamoto
Shinichi
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001017:Aortic Coarctation / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D013625:Takayasu Arteritis / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome