How effective is surgical repair of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Improvements in surgical techniques have led most cardiologists to recommend surgery at the time of diagnosis, especially in patients with hypertension. In patients with only mild obstruction, especially those diagnosed in the first year of life, surgery may safely be delayed and the patient monitored for worsening obstruction or development of hypertension prior to recommending surgery.

Pseudo-coarctation of the aorta refers to abnormal tortuosity of the aorta that does not result in significant obstruction or hypertension and is noted for the lack of development of collateral vessels. This abnormality does not require surgical intervention.

Surgical repair of coarctation of the aorta is accomplished in children and adolescents with generally good results and low mortality. Of 824 patients who underwent coarctation repair in childhood, 431 (52%) underwent end-to-end anastomosis, whereas patch aortoplasty was performed in 214 patients (26%) and only 109 patients (13%) underwent subclavian flap aortoplasty. Death occurred in only 6 of 824 patients for a total mortality rate of 0.73%. [27] The surgical era of this cohort does not reflect the current surgical strategy for aggressive complete arch repair or the aorta and all associated lesions. The trend is toward the less frequent use of patch aortoplasty because of concerns regarding the development of aortic aneurysm at the site of repair. [44, 45, 46, 47]

Operative mortality rates in neonates and infants are high (4-50%), whereas the operative mortality rates in older children are low (0-5%). The high mortality in the young infant appears to be related to the condition of the infant at the time of surgery and the associated defects.


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