Long-term results of surgical coarctectomy in the adolescent and young adult with 18-year follow-up

Background. There is no consensus in the literature regarding the optimal method for repair of coarctation of the aorta in the adolescent and young adult. Methods. We retrospectively reviewed operations in 45 patients treated between 1978 and 2003. Results. From 1978 to 2001, there were 45 adolescents or adults between the ages of 11 and 53 years (mean 21, SD ± 10) who underwent surgical correction. The perioperative mortality rate was 0% and the morbidity rate was 18%. All patients had improved blood pressure before discharge after a mean of 7 days, which ranged from 160/90 mm Hg to 90/50 mm Hg (mean 128/73 mm Hg, SD ± 17/12 mm Hg). This was an average improvement of 35 mm Hg (SD ± 26) compared with the preoperative pressure (p < 0.0005). Long-term results (defined as 5 years or more) were documented for 30 (71%) with a mean follow-up of 18.2 years (range, 67 to 293 months; SD ± 70 months). At the time of last follow-up, the blood pressure was documented and averaged 122/73 mm Hg (SD ± 11/10 mm Hg), which was a decrease of 36 mm Hg (SD ± 29) compared with the preoperative pressure (p < 0.0005). Seventy-six percent of patients were on no medications for hypertension. None of the 30 patients available for long-term follow-up has required a second operation for recurrence. Conclusions. Surgical repair of coarctation in the adolescent and adult is safe and durable, with a high success rate in curing patients of hypertension and making them medication-free for life. The recurrence rate is low, and most patients will not require any further intervention.