Late outcomes of reintervention on the descending aorta after repair of aortic coarctation.
BACKGROUND
After repair of aortic coarctation, patients may develop restenosis, aneurysms, and pseudoaneurysms at the site of prior repair. We assessed the outcomes of late reintervention on the descending aorta after aortic coarctation repair.


RESULTS
From March 1954 to July 2008, 130 patients had operations or endovascular procedures on the descending aorta after previous coarctation repair. We excluded patients who had complex left-sided cardiac lesions or interrupted aortic arch. Mean age at reintervention was 32±24 years and 28% were female. The interval between coarctation repair and reintervention was 17±13 years. Seventy-four percent of patients had hypertension. Reasons for reintervention were restenosis (n=122 [94%]), aneurysm (n=4 [3%]), and pseudoaneurysm (n=4 [3%]). Ninety-five patients (73%) underwent operative procedures including an extra-anatomic conduit (n=41), patch repair (n=32), interposition graft (n=14), end-end anastomosis (n=6), and subclavian flap (n=2). Thirty-five patients underwent endovascular treatment (balloon dilatation, n=22 or stenting, n=13). There was no early mortality. In the surgical group, 5 patients required early reoperation for bleeding and 5 patients had early vocal cord paralysis. One patient in the endovascular group had aortic rupture at the time of intervention requiring urgent operation. Survival was 97% at 10 years. At 5 years, freedom from a second repeat procedure on the descending aorta was 96% in the surgical group and 72% in the endovascular group (P<0.001). Five years after reintervention, fewer patients required treatment for hypertension (57% versus 74%, P<0.001) and a median of 1 antihypertensive medication was prescribed compared with a median of 2 medications preintervention.


CONCLUSIONS
Operative and endovascular management of recoarctation can be performed safely with good late outcomes.
Brown
Morgan L
ML
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
Burkhart
Harold M
HM
Connolly
Heidi M
HM
Dearani
Joseph A
JA
Hagler
Donald J
DJ
Schaff
Hartzell V
HV
D000293:Adolescent; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001017:Aortic Coarctation / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006083:Graft Occlusion, Vascular / Q000401:mortality / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors