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Surgical management of aortic coarctation in adolescents and adults.

Objectives
Coarctation of the aorta (CoA) in adolescents and adults is often complicated by other cardiac or aortic problems and may carry additional surgical difficulties. Limited studies have reported the surgical outcomes of CoA repair in this particular patient population. We reviewed our contemporary experience of open surgical management of CoA in adolescents and adults.


Methods
From 2008 to 2016, a total of 60 adolescents and adults (mean age, 32 years) underwent CoA repair at our centre. Of this cohort, 43 patients only underwent CoA repair (isolated group), while the remaining 17 underwent other concomitant cardiac procedures (concomitant group). Ascending-to-descending aortic bypass was the preferred repair technique in the concomitant group. Aortic valve replacement and a Bentall/David procedure were the two most frequently combined procedures.


Results
There were no in-hospital deaths in the isolated group compared with three in the concomitant group (0% vs 17.6%, P  = 0.029). The median intensive care unit stay (1 vs 2 days, P <0.01) and postoperative hospital stay (6 vs 9 days, P <0.01) were significantly longer in the concomitant group. Postoperative respiratory failure occurred more frequently in the concomitant group (0% vs 17.6%, P  = 0.029). The isolated group had better overall survival during follow-up ( P  = 0.037). The 5-year overall survival rate was 98% in the isolated group and 82% in the concomitant group.


Conclusions
Surgical management of coarctation in adolescents and adults can achieve similar satisfactory outcomes as their neonatal counterparts, but the complexity of the concomitant procedures is a risk factor for this particular patient population.