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Complications of coarctation repair
Stephanus J Serfontein1, Irving L Kron
1Department of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
Insights
Surgery for coarctation significantly improves life expectancy and quality of life. This review details common complications like recurrent coarctation, aneurysms, and spinal cord ischemia after aortic coarctation repair.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
Background:
- Coarctation repair is crucial for improving patient outcomes.
- Established surgical treatments offer undeniable benefits to life expectancy and quality of life.
Purpose of the Study:
- To review and discuss three major complications following aortic coarctation repair.
- To analyze incidence, causative factors, and treatment outcomes for these complications.
Main Methods:
- Comprehensive literature review of postaortic coarctation repair complications.
- Analysis of surgical and transcatheter treatment strategies.
- Investigation of etiologic factors and risk factors for adverse events.
Main Results:
- Recurrent or residual coarctation requires surgical or transcatheter intervention.
- Aneurysm formation is linked to specific repair techniques and patient factors.
- Spinal cord ischemia is a potential risk, with adenosine receptor agonists under investigation for prevention.
Conclusions:
- While complications can occur after coarctation repair, the overall risk is lower than untreated disease.
- Understanding and managing these complications is vital for optimizing patient care.
- Ongoing research aims to mitigate risks associated with coarctation surgery.
Abstract:
Surgery's role in the treatment of coarctation has been established, and the benefit to life expectancy and quality of life is undeniable. Three postaortic coarctation repair complications are discussed, with review of existing literature: recurrent or residual aortic coarctation, postrepair aneurysm formation, and spinal cord ischemia. Incidence, potential causative factors, and outcome of surgical or transcatheter treatment for recurrent and residual aortic coarctation are reviewed. A literature review of postrepair aneurysm formation focuses on etiologic factors such as use of patch aortoplasty repair techniques, aortic arch hypoplasia, congenital abnormality of the aortic wall, and persistent hypertension after repair. The spectrum, onset, incidence, and potential risk factors for postcoarctation repair spinal cord ischemia are reviewed. Use of adenosine receptor agonists to achieve a state of ischemic resistance is under investigation to address this potential hazard of coarctation repair. Complications after surgery do occur in certain subsets of patients, but the risk of subsequent intervention is still lower than the hazards associated with the natural course of the defect.