Work

Primary aortic coarctation repair in adolescents and adults

Year: 2024

Type: article

Abstract: Objective Optimal management of primary aortic coarctation in adolescents and adults remains controversial. We assess early and late mortality of repair, longitudinal antihypertensive regimens, and freedom from reintervention for repair-related complications. Methods From January 1, 1999, to July 1, 2023, 110 adolescents or adults, mean age 39 ± 16 years, underwent primary aortic coarctation repair at Cleveland Clinic. Patients were grouped by repair strategy: stented (60, 55%), grafted (interposition graft or extra-anatomic bypass; 36, 33%), or other (14, 13%). Longitudinal antihypertensive regimens were assessed parametrically. Freedom from reintervention and survival were assessed by the Kaplan–Meier method. Median follow-up for survival was 9.2 years. Results One patient (0.91%) died in-hospital. Major morbidity included stroke (2/107, 1.9%), tracheostomy (2/107, 1.9%), acute renal failure requiring dialysis (1/108, 0.93%), iatrogenic aortic dissection (1/107, 0.93%), and vascular access complication (1/56, 1.8%). Prevalence of patients requiring zero antihypertensive medications postoperatively peaked within 2 years. Twelve-year freedom from reintervention was 69% in the stented group and 97% in the grafted group ( P log-rank = .003). Most reinterventions were for in-stent restenosis of bare metal stents. Overall freedom from reintervention at 1, 5, and 12 years was 91%, 80%, and 76%, respectively. Overall survival was 98%, 95%, and 80% at 5, 10, and 14 years, respectively. Conclusions A tailored approach to coarctation repair in adolescents and adults using stented repair when anatomically feasible yields excellent short-term outcomes, but patients require persistent hypertension monitoring and have lower than expected long-term survival. Covered stents or stent grafts are preferred to bare metal stents, which are subject to in-stent restenosis.

Source: JTCVS structural and endovascular.

DOI: 10.1016/j.xjse.2024.100034