Early and Late Death of Surgically Treated Patients With Coarctation of the Aorta

Abstract

Patients with coarctation of the aorta undergo operation with low mortality risk in most medical centers. However, some patients do not survive operation or die early in the follow up period. We review our experience in 85 operated patients with coarctation of the aorta. Three expired during hospitalization and all had severe associated anomalies, specially those of the aortic valve. Another three patients died early in the follow up period due to an ascending aortic aneurysm rupture in one case and a massive bleeding through the infected suture line of the corrected coarctation in two cases.According to our experience and that of others, associated anomalies and rupture of the aortic aneurysms seems to be the most important causes of death in patients operated upon for coarctation of the aorta. Suture line infection of the corrected coarctation is an extremely rare complication but when it occurs it is almost always mortal, as it happened to our patients. It is our impression that all deaths reported here could have been easily avoided. A well planned surgical approach for patients with associated anomalies, an aggressive surgical treatment for aortic aneurysms and finally an antiendocarditic antibiotic coverage for patients operated upon for coarctation, are important measures in order to avoid or decrease early and late mortality. All operated patients should be followed closely if these complications are to be picked up and treated in an early stage.

Coarctation of the Aorta - The Current State of Surgical and Transcatheter Therapies

“…Endocarditis has been described in the past for patients with native coarctation [94], after surgical repair of coarctation [95] and also post balloon angioplasty [96]. Life-long endocarditis prophylaxis used to be recommended for patients with residual anatomic abnormalities who were undergoing dental work.…”

Coarctation of the Aorta - An Evolution of Therapeutic Options

“…Aneurysm development can be detected by magnetic resonance imaging [72] or by plain chest films [29], but transthoracic echocardiography has been shown to be less sensitive [29]. While endocarditis has been described for patients with native coarctation [73][74][75], and has been described for patients with surgically repaired coarctation [76,77], it has also been described in a patient after balloon angioplasty for native coarctation [78]. Therefore, life-long endocarditis prophylaxis is recommended for any patient with residual anatomic abnormality of the coarctation segment [79].…”

Coarctation of the thoracic aorta in adults: A follow-up study after surgical treatment

“…The use of synthetic graft increases the risk. The complication can appear a few days or several months after CoA repair, and, in cases with 12 no obvious infection, years afterwards (80,178). The factors responsible are presumably the same as in other types of arterial surgery: surgical failures in suturing the anastomosis; subacute bleeding with formation of a haematoma connected with the arterial lumen; prolonged duration of surgery; large incisions causing infection of the suture line; septicaemia with suture line infection; hypertension; anticoagulation; and possibly the suture material used (144,187).…”

“…Mortality is high, especially in the presence of fulminant infection; surgical excision of the infected aortic segment or graft and restoration of flow by means of bypass grafts offers hope in these cases (152). Pseudoaneurysm has been described as a complication after various CoA repair methods: after resection and end-toend anastomosis (64,178), after use of interposition prosthesis (33, 123); and after patch aortoplasty (95).…”