Abstract 4524: Late Outcomes of Reintervention on the Descending Aorta After Repair of Aortic Coarctation
Objective: After repair of aortic coarctation, patients may develop restenosis, aneurysms, and pseudoaneurysms. We assessed the outcomes of late reintervention on the descending aorta after aortic coarctation repair.
Methods: From March 1954 to July 2008, 130 patients had operations or endovascular procedures on the descending aorta after previous coarctation repair. We excluded patients who had complex left-sided cardiac lesions or had interrupted aortic arch.
Results: Mean age at reintervention was 32±24 years, 28% were female. The interval between coarctation repair and reintervention was 17±13 years. Seventy-four percent of patients had hypertension. Reasons for reintervention were restenosis (n=122,94%), aneurysm (n=4,3%), and pseudoaneurysm (n=4,3%). Ninety-five patients (73%) underwent operative procedures including an extra-anatomic conduit (n=41), patch repair(n=32), interposition graft(n=14), end-end anastomosis(n=6), and subclavian flap(n=2). Thirty-five patients underwent endovascular treatment (balloon dilatation, n=22 or stenting, n=13). There was no early mortality. In the surgical group, 5 patients required early reoperation for bleeding and 5 patients had early vocal cord paralysis. One patient in the endovascular group had aortic rupture requiring urgent operation. Survival was 97% at 10 years. At 5 years, freedom from a second repeat procedure on the descending aorta was 96% in the surgical group and 72% in the endovascular group (P<0.001). Five years after reintervention, fewer patients had hypertension (57%, P<0.001) and a median of 1 antihypertensive medication was prescribed.
Conclusions: Operative and endovascular management of recoarctation can be performed safely with good late outcomes. Patients who received an endovascular procedure required a greater number of subsequent interventions. Patients with aortic coarctation repair and reintervention for recoarctation require lifelong follow-up.