INFLUENCE OF AGE ON SURVIVAL, LATE HYPERTENSION, AND RECOARCTATION INELECTIVE AORTIC COARCTATION REPAIR - INCLUDING LONG-TERM RESULTS AFTER ELECTIVE AORTIC COARCTATION REPAIR WITH A FOLLOW-UP FROM 25 TO 44 YEARS

The optimal age for elective repair of aortic coarctation is controver sial. The optimal age should be associated with a minimal risk of reco arctation, late hypertension, and other cardiovascular disorders. The purpose of this retrospective study is to determine the actuarial surv ival after aortic coarctation repair 25 years or more after operation and to calculate the optimal age for elective aortic coarctation repai r. From 1948 to 1966, 120 consecutive patients underwent aortic coarct ation repair. Eighty-seven were male (72.5%). The mean age at operatio n was 15.5 years (SD +/- 9.1 years). Resection and end-to-end anastomo sis was performed in 103 patients (85.8%). Early mortality occurred in 6 patients as a result of surgical problems, whereas late mortality i n 15 patients was predominantly caused by cardiac causes. The mean fol low-up period was 32 years (range 25 to 44.2 years). Ninety-two patien ts (96.8%) were in New York Heart Association class I. The probability of survival 44 years after operation was 73%. Patients younger than 1 0 years at operation had the highest probability of survival at 97%. M ultivariate analysis produced age at operation as the only incremental risk factor for the occurrence of recoarctation, of late hypertension , and of premature death. So that these sequelae can be avoided, elect ive aortic coarctation repair should be performed around 1.5 years of age. At that age, the probability of recoarctation will have decreased to less than 3%, and the probability of upper body normotension and l ong-term survival will be optimal.