Outcomes of aortic coarctation surgical repair in adolescents and adults

Abstract

Objectives: Coarctation of the aorta (CoA) in adolescents and adults is relatively rare. Several operative techniques have been reported, but there is no consensus.

Methods: From November 1994 to July 2018, a total of 24 adolescents and adults underwent CoA repair. The mean age at operation was 29.9 ± 15.1; 19 (79%) patients were older than 18. Sixteen (67%) patients had arterial hypertension, 5 (21%) patients had bicuspid aortic valve, 4 (17%) patients had descending aneurysm, 2 (8%) patients had ascending aneurysm, 2 (8%) patients had patent ductus arteriosus and 1 (4%) patient had atrial septal defect. Three patients had prior surgery (2 CoA repair, 1 ventricular septal defect repair).

Results: Surgical corrections included extra-anatomical bypasses in 12 (50%) patients (9: left subclavian artery to descending aorta bypass, 2 proximal-to-distal coarctation bypasses, 1 ascending-to-descending aortic bypass), end-to-end anastomosis in 6 (25%) patients, resections and interpositions of a tube graft in 5 (21%) patients and arch augmentation with a tube graft in 1 (4%) patient. The mean follow-up duration was 6.2 ± 5.1 years. No mortality was observed. No patient required reoperation or reintervention. The mean upper extremity systolic pressure significantly decreased from 142.4 ± 30.3 mmHg preoperatively to 121.1 ± 15.9 mmHg postoperatively (P = 0.002). Arterial pressure gradient between upper and lower extremities significantly decreased from 50.0 ± 21.8 mmHg preoperatively to 9.7 ± 13.5 mmHg postoperatively (P < 0.001). Among patients undergoing left subclavian artery to descending aorta bypass, 8 patients underwent ankle brachial pressure index evaluation. Postoperative mean right- and left-sided ankle brachial pressure index were 0.96 ± 0.16 and 0.94 ± 0.11, respectively. All grafts were patent at the last follow-up.

Conclusions: CoA repair in adolescents and adults showed good outcomes. Left subclavian artery to descending aorta bypass grafting is safe and effective for managing CoA in adolescents and adults.

Keywords: Adult; Coarctation of the aorta; Congenital heart disease.