Long-term follow-up after aortic coarctation repair: The unsolved issue of exercise-induced hypertension

Aim. A growing interest in the use of sternotomy and perfusion for repair of aortic coarctation in neonates and infants has enabled us to retrospectively review our own experience in this practice. Our purpose was to determine the efficacy of coarctation repair with extended end-to-end anastomosis through left thoracotomy focusing on a re-intervention rate and dynamics of transverse aortic arch growth during long-term follow-up. Methods. One hundred and twenty-four patients under 3 months old who underwent coarctation repair (between 2008 and 2016) were enrolled in this study. In 43 patients (35%), aorta coarctation was combined with ventricular septal defect, 49 patients (39.5%) had transversal aortic arch hypoplasia (Z-score less than –2). All operations were carried out by using extended “end-to-end” anastomosis technique via thoracotomy. In patients with concomitant ventricular septal defect, PA-banding was performed simultaneously. Overall follow-up was 3.6 (0.3–8.0) years. Results. Early mortality was 1.6%. Late survival rate was 93.5%. Recurrent aortic arch obstruction was revealed in 10 (8%) patients, on the average, in 6.5 (3.5–15) months after coarctation repair. Management of re-stenosis with balloon aortoplasty was effective in all cases and had no complications. A statistically significant growth (p<0.001) of the transverse aortic arch was observed in those patients who had hypoplasia of the arch before surgery. Conclusion. Repair of coarctation of the aorta by resection and extended “end-to-end” anastomosis via thoracotomy without perfusion has low operative mortality, an excellent survival rate and a reduced rate of balloon re-intervention. Patients with baseline moderate transverse aortic arch hypoplasia demonstrate a growth of the aorta up to normal values in long-term follow-up. Endovascular balloon dilatation of aortic re-coarctation zone during long-term follow-up is an effective and safe procedure. Received 20 June 2018. Revised 5 September 2018. Accepted 12 September 2018. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributions Conception and study design: V.N. Ilyin Data collection and analysis: M.M. Belyaeva, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina Drafting the article: M.M. Belyaeva Critical revision of the article: V.N. Ilyin, O.Yu. Kornoukhov Final approval of the version to be published: M.M. Belyaeva, V.N. Ilyin, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina

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Endovascular repair of severe aortic coarctation, transcatheter aortic valve replacement for severe aortic stenosis, and percutaneous coronary intervention in an elderly patient with long term follow-up

Journal of the Saudi Heart Association ◽

10.1016/j.jsha.2018.01.003 ◽

2018 ◽

Vol 30 (3) ◽

pp. 271-275 ◽

Cited By ~ 1

Author(s):

Raneem Fallatah ◽

Abdelfatah Elasfar ◽

Osama Amoudi ◽

Mohamed Ajaz ◽

Ibraheem AlHarbi ◽

...

Keyword(s):

Elderly Patient ◽

Aortic Coarctation ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Coronary Intervention ◽

Transcatheter Aortic Valve ◽

Percutaneous Coronary ◽

Long Term Follow Up

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Results of Coarctation Repair by Thoracotomy in Pediatric Patients: A Single Institution Experience

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211003505 ◽

2021 ◽

Vol 12 (4) ◽

pp. 492-499

Author(s):

Louis Heremans ◽

Arnaud Henkens ◽

Geoffroy de Beco ◽

Karlien Carbonez ◽

Stéphane Moniotte ◽

...

Keyword(s):

Aortic Coarctation ◽

Interrupted Aortic Arch ◽

Long Term Results ◽

Coarctation Repair ◽

Group 3 ◽

Group 2 ◽

Patient Prognosis ◽

Group 1

Background: Aortic coarctation is among the most common cardiovascular congenital abnormalities requiring repair after birth. Besides mortality, morbidity remains an important aspect. Accordingly, we reviewed our 20-year experience of aortic coarctation repair by thoracotomy, with emphasis on both short- and long-term outcomes. Methods: From 1995 through 2014, 214 patients underwent coarctation repair via left thoracotomy. Associated arch lesions were distal arch hypoplasia (n = 117) or type A interrupted aortic arch (n = 6). Eighty-four patients had isolated coarctation (group 1), 66 associated ventricular septal defect (group 2), and 64 associated complex cardiac lesions (group 3). Median follow-up was 8.4 years. Results: There was one (0.5%) procedure-related death. Nine (4.2%) patients died during index admission. In-hospital mortality was 0.7% in group 1 and 2 and 12.5% in group 3 ( P < .001). No patient had paraplegia. Actuarial five-year survival was 97.5% in group 1, 94% group 2 and 66% in group 3. Recurrent coarctation developed in 29 patients, all but four (1.8%) successfully treated by balloon dilatation. Freedom from reintervention (dilatation or surgery) at five years was 86%. At hospital discharge, 28 (13.5%) patients were hypertensive. At follow-up, hypertension was present in 11 (5.3%) patients. Conclusions: Long-term results of aortic coarctation repair by thoracotomy are excellent, with percutaneous angioplasty being the procedure of choice for recurrences. Patient prognosis is dependent on associated cardiac malformations. In this study, the prevalence of late arterial hypertension was lower than previously reported.

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Long-term follow-up of aortic coarctation in infants, children and adults

Cardiology in the Young ◽

10.1017/s1047951100010568 ◽

1993 ◽

Vol 3 (1) ◽

pp. 20-26 ◽

Cited By ~ 2

Author(s):

Prasad Mathew ◽

Douglas Moodie ◽

Gary Blechman ◽

Carl C. Gill

Keyword(s):

Aortic Coarctation ◽

Operative Mortality ◽

Postoperative Mortality ◽

Cardiovascular Complications ◽

Long Term Follow Up ◽

Cardiac Lesions ◽

Discharge From Hospital ◽

Age Range

AbstractWe have studied 140 patients undergoing corrective surgery for aortic coarctation between 1952 and 1972, following them for a mean period of 23 years. Of the patients, 19 underwent surgery in infancy (age range 15 days to 190 days, mean 84 days), 52 during childhood, with a mean age of 11.8 years (range 1 years), and 69 as adults (age range 18−50 years, mean 30.5 years). All infants were symptomatic at presentation and fared poorly because of associated cardiac lesions. Their operative mortality was 11%, and mortality prior to discharge from hospital was 21%. Of the survivors, 38% required surgery for recurrent coarctation. There were three late deaths. Of the survivors, 90% were asymptomatic at long-term follow-up. Only six children (11%) were symptomatic at presentation. There was no operative or early postoperative mortality, and only three late deaths (6%). Of the 49 survivors, 96% were asymptomatic, and only six required antihypertensive medication. The recoarctation rate was 9% (four patients). In the group undergoing surgery as adults, 42% were symptomatic at presentation with 90% being hypertensive. There were two postoperative deaths and a late mortality of 22%, which was mainly related to the cardiovascular complications. None of the adults had suffered recoarctation, but 48% remained hypertensive. Our study confirms that the prognosis of patients with aortic coarctation presenting in infancy is related to presence of associated cardiac anomalies and operative complications. The prognosis in older patients, and particularly adults, is related to residual hypertension and resultant cardiovascular disease. Surgical correction reduces symptoms and improves life expectancy, regardless of the age at operation, with the best overall prognosis being obtained for those undergoing surgery as children.

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