REPAIR OF COARCTATION OF THE AORTA IN ADULTS - THE FATE OF SYSTOLIC HYPERTENSION

Background. The benefit of coarctation repair in adults has been quest ioned by suggesting that hypertension may not be relieved by the opera tion and that surgical intervention may have no impact on the natural history of the disease. Methods. To delineate the impact of surgical i ntervention on systolic hypertension, we conducted a retrospective rev iew of 26 adults with a mean age of 32 +/- 10 years who underwent coar ctation repair between 1987 and 1993. All patients were hypertensive ( mean systolic blood pressure, 174 +/- 21 mm Hg; range, 140 to 220 mm H g), and 18 patients (69%) were on a regimen of at least one hypertensi ve medication at the time of surgical admission. All patients underwen t catheterization, and the mean peak systolic gradient across the coar ctation was 61 +/- 25 mm Hg (range, 25 to 120 mm Hg). Operation includ ed resection and end-to-end anastomosis (3 patients), resection with a n interposition tube graft (6 patients), a bypass graft (11 patients), and patch angioplasty (6 patients). There was no hospital mortality o r late morbidity. Results. Intermediate follow-up was available at a m ean of 2.3 +/- 2 years (range, 1 to 7 years). At last follow-up, the p eak systolic gradient between the upper and lower body was trivial (le ss than or equal to 10 mm Hg) in 23 patients (88%) and mild (11 to 20 mm Hg) in 3 (12%). All patients had significant improvement in systoli c blood pressure (p < 0.001) compared with preoperative values, and th e majority (23, 88%) were normotensive. More than half of the patients (14, 54%) were still on a regimen of antihypertensive medication at l ast follow-up, with a trend (p = 0.06) toward older patients requiring medication.Conclusions. Surgical repair of coarctation in adults is a n effective, low-risk procedure, which results in a significant improv ement in systolic hypertension and a decreased requirement of antihype rtensive medications.