Document Detail


Late outcomes of reintervention on the descending aorta after repair of aortic coarctation.
MedLine Citation:
PMID:  20837930     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: After repair of aortic coarctation, patients may develop restenosis, aneurysms, and pseudoaneurysms at the site of prior repair. We assessed the outcomes of late reintervention on the descending aorta after aortic coarctation repair. METHODS AND RESULTS: 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 interrupted aortic arch. Mean age at reintervention was 32±24 years and 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 at the time of intervention 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 required treatment for hypertension (57% versus 74%, P<0.001) and a median of 1 antihypertensive medication was prescribed compared with a median of 2 medications preintervention. CONCLUSIONS: Operative and endovascular management of recoarctation can be performed safely with good late outcomes.
Authors:
Morgan L Brown; Harold M Burkhart; Heidi M Connolly; Joseph A Dearani; Donald J Hagler; Hartzell V Schaff
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-14     Completed Date:  2010-10-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S81-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aorta, Thoracic / surgery*
Aortic Coarctation* / mortality,  surgery
Disease-Free Survival
Female
Graft Occlusion, Vascular* / mortality,  surgery
Humans
Hypertension / mortality
Male
Middle Aged
Retrospective Studies
Survival Rate
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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