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[Isolated aortic isthmus stenosis: operation indications and results]
Insights
Surgical correction of coarctation of the aorta aims to normalize blood pressure. However, delaying surgery past age five increases the risk of persistent hypertension due to elevated systemic arterial resistance, even with initially normal blood pressure post-operation.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hypertension Research
Context:
- Coarctation of the aorta (CoA) is a congenital heart defect requiring surgical intervention.
- Optimal timing for surgical correction is crucial for long-term outcomes.
- Previous studies have focused on immediate postoperative blood pressure, but long-term resistance is key.
Purpose:
- To determine the optimal age for surgical correction of isolated coarctation of the aorta.
- To analyze the relationship between age at surgery and postoperative outcomes, including hypertension and systemic arterial resistance.
- To evaluate the impact of surgical timing on morbidity, mortality, residual stenosis, and recoarctation rates.
Summary:
- Analysis of 237 patients revealed that while blood pressure decreases post-surgery, persistent hypertension without recoarctation increases with later surgical intervention (after age 6).
- Systemic arterial resistance is elevated by age 3-5 and further increases with later surgery, posing a risk for future hypertension.
- Surgery after age five, particularly after age six, is associated with a higher risk of developing hypertension due to persistent elevated resistance, irrespective of immediate blood pressure readings.
Impact:
- Identifies age-related risks associated with surgical correction of coarctation of the aorta.
- Highlights the importance of considering systemic arterial resistance, not just blood pressure, for prognosis.
- Suggests that earlier surgical intervention may be beneficial to mitigate long-term hypertension risks in patients with coarctation of the aorta.
Abstract:
The goal of surgical correction of isolated coarctation of the aorta is normalization of the blood pressure. To assess the optimal age for the intervention with respect to operative morbidity and mortality, residual stenosis and recoarctation rate as well as the postoperative persistence of arterial hypertension without recoarctation, the pre- and postoperative findings of 237 patients (age at surgery: range one week to 17 years) were analyzed. The blood pressure, which was above the 95th percentile of age-matched normal values preoperatively in 93%, showed a clear decrease postoperatively in all age groups. On surgical correction, however, performed as of six years of age, there was a continuously increasing rate of persistent arterial hypertension without recoarctation which ranged from about 10% in those undergoing surgery between the ages of six and eight years to 31% in patients operated at ages between 13 and 17 years. In consideration of the operative results only with respect to the response of the resting blood pressure, insight is enabled only into one aspect of the prognosis, since the latter is equally dependent on the postoperative systemic arterial resistance. The systemic arterial resistance is already slightly elevated at three to five years of age, significantly increased as of six years of age, and at surgery after the age of six, shows a further increasing tendency. Accordingly, patients with postoperative normal or borderline-elevated blood pressure and apparently adequate surgical results, may be at risk of subsequent development of hypertension due to persistence of increased resistance, in particular, if surgery is performed after the age of five years.(ABSTRACT TRUNCATED AT 250 WORDS)