Complications of coarctation repair

Surgery's role in the treatment of coarctation has been established, and the benefit to life expectancy and quality of life is undeniable. Three postaortic coarctation repair complications are discussed, with review of existing literature: recurrent or residual aortic coarctation, postrepair aneurysm formation, and spinal cord ischemia. Incidence, potential causative factors, and outcome of surgical or transcatheter treatment for recurrent and residual aortic coarctation are reviewed. A literature review of postrepair aneurysm formation focuses on etiologic factors such as use of patch aortoplasty repair techniques, aortic arch hypoplasia, congenital abnormality of the aortic wall, and persistent hypertension after repair. The spectrum, onset, incidence, and potential risk factors for postcoarctation repair spinal cord ischemia are reviewed. Use of adenosine receptor agonists to achieve a state of ischemic resistance is under investigation to address this potential hazard of coarctation repair. Complications after surgery do occur in certain subsets of patients, but the risk of subsequent intervention is still lower than the hazards associated with the natural course of the defect.