Surgery for aortic coarctation: a 30 years experience

Objective: A retrospective study to review the experience of a single center with surgery for aortic coarctation over a period of 30 years (1970-1999). Methods: Criteria for inclusion: (a) aortic coarctation, isolated or associated with congenital heart defect; (b) surgery between 1970 and 1999. Data recorded: (1) date of surgery, (2) age at surgery: (3) associated lesions (4) surgical technique: (5) simultaneous surgical procedures; (6) early and late surgical results in term of: (a) deaths; (b) need for reoperation because of re-coarctation or other cardiac lesion; (c) residual/recurrent pressure gradient, evaluated at cuff/Doppler at rest; (d) systemic hypertension, requiring medical treatment. Results: One hundred and forty-one patients underwent surgery for aortic coarctation: 30 neonates, 29 infants, 45 children and 37 adults. Associated lesions were found in 8/37 ( = 21.6%) adults and in 73/104 ( = 70.1%) pediatric patients. There were no hospital deaths. During the followup there were one late death in the adults group (1/37 = 2.7%) and three late deaths in the pediatric group (3/104 = 2.9%). all unrelated with aortic coarctation. Re-operation because of re-coarctation occurred only in ten late survivors of the pediatric group ( 10/101 = 9.9%), 9/10 operated on before 1980 (P < 0.00001). End-to-end anastomosis, enlarged to the aortic arch in neonates. was associated with the lowest incidence of re-coarctation (P < 0.005). A significant (> 20 mmHg at rest) pressure gradient was found in none of (fie adults, and in seven of the 91 pediatric patients (7/91 = 7.7%) late survivors. Three adults (3/36 = 8.3%) late survivors are on medical treatment to control systemic hypertension. Conclusions: The long-term results of our retrospective study confirm that surgery has to be considered the gold standard for the treatment of aortic coarctation. The interventional angioplasty techniques have to provide long-term outcome at least similar to the results obtained with surgery. (C) 2001 Elsevier Science B.V. All rights reserved.