Coarctation of the aorta in adults: Surgical results and long-term follow-up

Background. The aim of this retrospective study was to determine the impact of coarctation surgical repair on arterial blood pressure in adults more t han 20 years of age. Methods. Thirty-five adults (23 men), mean age 28.1 +/- 5.7 years (range, 2 1 to 52 years), underwent coarctation surgical repair between 1977 and 1997 . All patients had preoperative hypertension. Mean systolic blood pressure was 178 +/- 37 mm Hg (range, 110 to 230 mm Hg). Thirty-three patients were taking at least one hypertension medication at the time of operation. All p atients had preoperative catheterization and angiography (mean gradient acr oss the coarctation was 62 +/- 27 mm Hg [range, 32 to 130 mm Hg]). Operativ e technique was resection and end-to-end anastomosis for 30 patients, resec tion with Dacron (C. R. Bard, Haverhill, MA) graft for 4 patients, and a pr osthetic bypass graft for 1 patient. There were no hospital deaths and no l ate morbidity. Results. All patients were reviewed. Follow-up was 165 +/- 56 months (range , 25 to 240 months). Of the 35 patients with preoperative hypertension, 23 were normotensive (systolic blood pressure less than or equal to 140 mm Hg, diastolic blood pressure less than or equal to 90 mm Hg) with no medicatio n. Twelve patients were receiving medication: 6 required single-drug therap y and 6 patients required two drugs. Exercise testing was performed at an a verage of 6 +/- 4 months after repair and revealed hypertensive response to exercise in 8 of the 23 patients who were normotensive at rest and without medication. There were no recoarctation or repeat operations. Six aortic v alve diseases were observed: three aortic incompetences (two bicuspid valve s) treated by two valve replacements and one Bentall procedure, and three a ortic stenoses (two valve replacements). No patient had evidence of a cereb rovascular accident. Conclusions. Surgical repair of coarctation in adults has proved to be an e ffective procedure and significantly reduces arterial hypertension. However , long-term surveillance is mandatory and should include exercise testing t o identify patients with potential hypertension. (Ann Thorac Surg 2000;70:1 483-9) (C) 2000 by The Society of Thoracic Surgeons.