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

Morgan L. Brown, Harold M. Burkhart, Heidi M. Connolly, Joseph A. Dearani, Donald J. Hagler, Hartzell V Schaff

Research output: Contribution to journalArticle

39 Citations (Scopus)

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.

Original languageEnglish (US)
JournalCirculation
Volume122
Issue number11 SUPPL. 1
DOIs
StatePublished - Sep 14 2010

Fingerprint

Aortic Coarctation
Thoracic Aorta
False Aneurysm
Aneurysm
Hypertension
Vocal Cord Paralysis
Aortic Rupture
Endovascular Procedures
Operative Surgical Procedures
Reoperation
Antihypertensive Agents
Dilatation
Hemorrhage
Transplants

Keywords

  • aorta
  • coarctation
  • hypertension
  • stents
  • surgery

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. / Brown, Morgan L.; Burkhart, Harold M.; Connolly, Heidi M.; Dearani, Joseph A.; Hagler, Donald J.; Schaff, Hartzell V.

In: Circulation, Vol. 122, No. 11 SUPPL. 1, 14.09.2010.

Research output: Contribution to journalArticle

Brown, Morgan L. ; Burkhart, Harold M. ; Connolly, Heidi M. ; Dearani, Joseph A. ; Hagler, Donald J. ; Schaff, Hartzell V. / Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. In: Circulation. 2010 ; Vol. 122, No. 11 SUPPL. 1.
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AU - Schaff, Hartzell V

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KW - stents

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