Critical review of experience with surgical repair of coarctation of the aorta

Repair of coarctation of the aorta has been performed in 164 patients since July, 1947. Eighteen were younger than 6 months of age, 44 were I to 11 years, 87 were 11 to 40 years, and 15 were older than 40 years of age. Resection and end-to-end anastomosis were performed in 92, interposition grafts in 59, and other procedures in 13. Four operative deaths occurred in infants with multiple anomalies (22 percent infant mortality rate). Ten late deaths were due to associated anomalies (three), myocardial infarction (two), cerebrovascular accident (one), rupture of an aneurysm at the graft site (one), and unrelated causes (three). No hospital deaths occurred in patients with isolated coarctation or in patients older than 1 year, including the 15 patients older than 40 years. Late complications were evaluated in 147 patients followed from 2 months to 28 years. Restenosis occurred in eight (three repaired when younger than 6 months) and false aneurysm at graft sites in two (fatal rupture in one). Residual hypertension occurred in 38 of 147 (25.9 percent) and was related to age at the time of repair: younger than 6 months (three of 13), 1 to 11 years (one of 43), 11 to 40 years (29 of 79), and older than 40 years (five of 13). Residual hemodynamic abnormality due to uncorrected associated anomalies, hypertension, ventricular hypertrophy, coronary artery disease, restenosis, or anastomotic aneurysm occurred in 56.1 percent of 98 patients followed at least 2 years. Of this group, 21.4 percent of those repaired before age 11 years and 70 percent of those repaired after age 11 had residual hemodynamic abnormality. Hypertension and other residual hemodynamic abnormalities occur frequently after coarctation repair, but significantly less often when repair is performed between the ages of 1 and 11 years. The incidence of mild hypertension is increased if repair is performed after 6 years of age.