Recurrent aortic coarctation: Is surgical repair still the gold standard?

Abstract

Although the treatment of aortic coarctation has improved significantly during the past decades, persistent hypertension after repairs at an older age and recurrent coarctation after repairs in neonates occur in all institutions. Surgeons have not agreed on the optimal approach to primary coarctation repair, and invasive cardiologists have challenged operative intervention for both recurrent and primary coarctation. This study demonstrates that surgical repair of recurrent coarctation of the aorta can be performed safely and with excellent results. We believe it is still the gold standard in the management of recurrent coarctation of the aorta.

Percutaneous Endovascular Repair of Aneurysm After Previous Coarctation Surgery

“…[7][8][9] However, relapse after coarctation repair and complications related to surgical procedures are not uncommon, with aneurysm formation, stenosis, or occlusion of bypass grafts. 10 -12 Recurrent coarctation used to be the only late complication amenable to interventional treatment in lieu of surgical graft interposition or end-to-end anastomosis [13][14][15] ; postsurgical aneurysm may quality next for interventional repair.…”

Endovascular stent placement is an acceptable alternative to reoperation in selected infants with residual or recurrent aortic arch obstruction

“…In these cases, surgical and medical management frequently becomes complicated with significant risk of morbidity and mortality [7,8]. Surgical repair of native aortic arch obstruction remains the therapy of choice in infants even though endovascular management options are increasingly being used in older children and adults [9][10][11][12]. Aortic angioplasty for coarctation of aorta in infants, whilst possible, has been shown to be associated with a high incidence of recurrence and remains controversial [10,13].…”

“…Endovascular stent therapy in infants is likely to be superior to angioplasty in affording a lasting result but is limited because there is currently no stents deliverable through small sheaths capable of being dilated to adult aortic size and even when this technology becomes available the child would need to return for repeated stent dilation through childhood. Surgical techniques for repair of infant coarctation of aorta has advanced such that mortality is now low [9,14]. However, some aortic arch repairs in small infants are complex with appreciable morbidity and mortality [8,14].…”

Late Outcomes of Reintervention on the Descending Aorta After Repair of Aortic Coarctation

“…The majority of rerepairs were performed with a patch and there were no deaths or major complications noted. 7 Our study differs in that our population was older (mean age, 32 years) at the time of reintervention, our most common procedure was an extra-anatomic conduit (32%), and we included endovascular procedures.…”

“…However, although endovascular treatment for recoarctation or pseudoaneurysm has been reported frequently in the literature, [2][3][4][5][6] there are fewer institutions reporting the outcomes of operative reinterventions after coarctation repair. [7][8][9][10][11] The American College of Cardiology and American Heart Association guidelines for adults with congenital heart disease recommend percutaneous catheter intervention for recurrent discrete coarctation of the aorta. 12 Surgery is advised for long segments of recoarctation and concomitant hypoplasia of the aortic arch.…”