Severe late complications after operative correction of aortic coarctation by interposition of prosthesis

Out of 198 patients with aortic coarctation who were operated on with the implantation of an orthotopic bypass vascular prosthesis, 7 developed severe late complications 9-20 years postoperatively with late anastomosis dehiscence which resulted either in acute rupture and sudden death from massive hemorrhage (2 patients) or in false aneurysms with or without delayed rupture. Reoperation was done in 4 patients. After elective reoperation 2 of 3 patients survived, one elective and one emergency case died. The only evident reason for the late suture disruption was complete absorption of polyamide suture material in 6 cases. Therefore all patients with polyamide-sutured anastomosis should be followed-up thoroughly even in the late postoperative period in order to detect indications for elective reoperation. Suture material for anastomosis with any prosthesis must be nonabsorbable for lifetime.