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Late outcomes of reintervention on the descending aorta after repair of aortic coarctation.

Abstract：

BACKGROUND:After repair of aortic coarctation, patients may develop restenosis, aneurysms, and pseudoaneurysms at the site of prior repair. We assessed the outcomes of late reintervention on the descending aorta after aortic coarctation repair. METHODS AND RESULTS:From March 1954 to July 2008, 130 patients had operations or endovascular procedures on the descending aorta after previous coarctation repair. We excluded patients who had complex left-sided cardiac lesions or interrupted aortic arch. Mean age at reintervention was 32±24 years and 28% were female. The interval between coarctation repair and reintervention was 17±13 years. Seventy-four percent of patients had hypertension. Reasons for reintervention were restenosis (n=122 [94%]), aneurysm (n=4 [3%]), and pseudoaneurysm (n=4 [3%]). Ninety-five patients (73%) underwent operative procedures including an extra-anatomic conduit (n=41), patch repair (n=32), interposition graft (n=14), end-end anastomosis (n=6), and subclavian flap (n=2). Thirty-five patients underwent endovascular treatment (balloon dilatation, n=22 or stenting, n=13). There was no early mortality. In the surgical group, 5 patients required early reoperation for bleeding and 5 patients had early vocal cord paralysis. One patient in the endovascular group had aortic rupture at the time of intervention requiring urgent operation. Survival was 97% at 10 years. At 5 years, freedom from a second repeat procedure on the descending aorta was 96% in the surgical group and 72% in the endovascular group (P<0.001). Five years after reintervention, fewer patients required treatment for hypertension (57% versus 74%, P<0.001) and a median of 1 antihypertensive medication was prescribed compared with a median of 2 medications preintervention. CONCLUSIONS:Operative and endovascular management of recoarctation can be performed safely with good late outcomes.

journal_name

Circulation

journal_title

Circulation

authors

Brown ML,Burkhart HM,Connolly HM,Dearani JA,Hagler DJ,Schaff HV

doi

10.1161/CIRCULATIONAHA.109.925172

subject

Has Abstract

pub_date

2010-09-14 00:00:00

pages

S81-4

issue

11 Suppl

eissn

0009-7322

issn

1524-4539

pii

122/11_suppl_1/S81

journal_volume

122

pub_type

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Late outcomes of reintervention on the descending aorta after repair of aortic coarctation.