Surgical treatment of isolated coarctation of the aorta: 18 years' experience
Insights
Optimal surgical timing for coarctation of the aorta is crucial. Early repair in children under one year may increase recurrence risk, while later surgery is linked to persistent hypertension.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Coarctation of the aorta is a congenital heart defect requiring surgical intervention.
- Surgical techniques for coarctation of the aorta have evolved over time.
- Long-term outcomes related to age at repair and surgical method are critical.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical repair for isolated coarctation of the aorta.
- To determine the impact of patient age at the time of surgery on recurrence and hypertension.
- To identify the optimal age for elective coarctation of the aorta repair.
Main Methods:
- Retrospective analysis of 91 patients who underwent surgical treatment for coarctation of the aorta between 1967 and 1985.
- Categorization of patients into age groups: 0-5 years, 6-15 years, and over 15 years.
- Follow-up of 86 patients for a mean of 10 years to assess recurrence, mortality, and hypertension.
Main Results:
- No hospital or late deaths, and no spinal cord injuries were reported.
- Three recurrences of coarctation occurred, exclusively in patients operated on before one year of age.
- Late hypertension was absent in the 0-5 year group, present in 7% of the 6-15 year group, and 28% of the over 15 year group.
Conclusions:
- Surgical repair of coarctation of the aorta before one year of age is associated with a higher risk of recurrence.
- Older age at repair, particularly over 20 years, and tube graft replacement correlate with persistent hypertension.
- Elective surgery for coarctation of the aorta is recommended between 3-5 years of age to minimize recurrence and late hypertension.
Abstract:
From March 1967 to February 1985 91 patients aged from 11 months to 53 years underwent surgical treatment of isolated coarctation of the aorta. The surgical procedures in descending order of frequency, were: resection with end to end anastomosis, resection with replacement by a tube graft, patch aortoplasty, and bypass graft. Resection with end to end anastomosis was achieved mainly in younger patients. The number of patients needing other procedures increased with advancing age. Eighty six patients have been followed up (mean 10 years). There were no hospital or late deaths and none of the patients suffered from spinal cord injury. There were three recurrences of the coarctation, all in patients who had had primary reconstruction below the age of one year. The patients were divided into three groups by age: group 1, 0-5 years; group 2, 6-15 years; and group 3, over 15 years. It was found that there was no late hypertension in group 1 while hypertension persisted in 7% of group 2 and in 28% of group 3. Fifty per cent of the patients with persistent hypertension were above the age of 20 years at the time of operation and had resection with replacement by a tube graft. It is recommended that elective surgery for coarctation of the aorta should be performed at the age of 3-5 years to avoid both recurrence of stenosis and persistent hypertension.
