Original ArticlesRepair of coarctation of the aorta during infancy minimizes the risk of late hypertension
Section snippets
Material and methods
The records of the 176 consecutive patients undergoing a surgical procedure for coarctation of the aorta between 1969 and 1995 were reviewed. This retrospective study reviewed operative notes, follow-up clinic visits, and postoperative echocardiographic and cardiac catheterization data. Ninety-nine percent of the patients have been followed up for a mean of 7.5 years (range, 6 months to 24 years).
The median age at operation was 11 months (range, 1 day to 33 years). The patients were grouped
Mortality
Six patients died within 30 days of the operation, for an operative mortality of 3.4%. An additional 7 patients died between 3 months and 6 years after the operation, for an overall mortality of 7.4%. Survival was in part determined by associated cardiac anomalies. There were no deaths in the 113 patients with isolated coarctation (class 1). Two of the 27 class 2 patients (7.4%) died. Eleven of the 36 class 3 patients (30.6%) died. Univariate analysis showed that determinants of mortality
Surgical techniques
The evolving operative approaches used to repair coarctation of the aorta in our institution during the past 25 years have reflected our attempts to establish the optimal surgical procedure. We could not demonstrate an advantage for any of the surgical approaches in minimizing mortality, recurrence, or late hypertension. These findings are similar to those reported by other investigators 12, 13, 14, 16, 25. In the absence of a large, randomized study, superiority of one technique over another
Summary
In summary, the findings in this study indicate that the optimal age for elective surgical relief of coarctation of the aorta is during the first year of life. Although the incidence of recurrence was relatively low and unrelated to the surgical approach, identification and proper treatment of recoarctation at an early age are imperative to minimize the development of late hypertension.
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Cited by (118)
Coarctation of the aorta: Prenatal assessment, postnatal management and neonatal outcomes
2022, Seminars in PerinatologyCitation Excerpt :At many large scale surgical centers, these criteria are ascribed to the neonatal setting. Data on the importance of intervention in infancy or early childhood to prevent long-term systemic hypertension and the low mortality rate in neonatal period support this approach.46,47 However, in pre-term or particularly young infants, the risk of intervention is higher and must be balanced with the severity of coarctation.48
Arterial stiffness and pulsatile hemodynamics in congenital heart disease
2022, Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and DiseaseMaternal Congenital Heart Disease in Pregnancy
2018, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :Aortic coarctation is found in approximately 4% to 6% of congenital cardiac anomalies and can be associated with aortic dilatation, bicuspid aortic valve, and aortic stenosis.30 Typically, coarctation repair is recommended early in life or at the time of diagnosis in order to prevent systemic hypertension31; thus, most pregnant women will have a repaired coarctation. Signs of significant aortic coarctation include hypertension isolated to the upper body or decreased femoral pulses.30
Outcomes of thoracic endovascular aortic repair in adult coarctation patients
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