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Coarctation repair with prosthetic material: surgical experience with aneurysm formation.

BACKGROUND
Late aneurysm formation is a common complication after repair of an aortic coarctation with prosthetic material; its incidence varies between 5 and 46%. We reviewed our experience with the management of this complication and propose a radical surgical treatment, which has proved to be free from severe complications; furthermore, we suggest the possibility of a new percutaneous management of this complication.


METHODS
From September 1974 to November 2002, 195 patients underwent primary repair of an aortic coarctation with prosthetic material (Dacron, polytetrafluorethylene or heterologous pericardium), with patch aortoplasty as the most common technique. During the follow-up period, reoperation for aneurysm formation was required in 13 asymptomatic patients. The diagnosis was made at angiography in 3 patients and at magnetic resonance imaging in 10. The indication for reoperation was an isthmic-diaphragmatic aortic diameter ratio > 1.5. Aneurysmectomy and tube graft interposition was performed in 12 patients; femoro-femoral cardiopulmonary bypass with a period of deep hypothermic circulatory arrest was carried out in 7 cases while 5 patients were submitted to normothermic atrio-femoral bypass; 1 patient underwent endovascular prosthesis implantation.


RESULTS
There were no in-hospital deaths. Three patients experienced postoperative complications: bleeding (n = 1), left phrenic nerve paresis (n = 1), and chylothorax (n = 1). The mean follow-up period was 51.8 +/- 46.2 months; all patients were asymptomatic without clinical or instrumental evidence of recurrence.


CONCLUSIONS
Aneurysm formation after primary repair of an aortic coarctation using prosthetic material is a potentially worrisome late complication and lifelong surveillance of these patients by means of magnetic resonance is mandatory. Surgical management, when indicated, has proved to be a definitive treatment and free from major complications. In highly selected patients, interventional management by percutaneous techniques may provide promising results.