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J Thorac Cardiovasc Surg 1998;116:560-565
© 1998 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

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

Indianapolis, Ind

From the Department of Surgery, Division of Cardiothoracic Surgery, Riley Children's Hospital, Indiana University, Indianapolis, Ind.

Received for publication Feb 3, 1998. Revisions requested March 4, 1998; revisions received April 27, 1998. Accepted for publication June 16, 1998. Address for reprints: John W. Brown, MD, Professor and Chairman, Department of Surgery, Division of Cardiothoracic Surgery, Emerson Hall, 545 Barnhill Dr, Indiana University Medical Center, Indianapolis, IN 46202.

Objective: We reviewed our experience with surgical repair compared with balloon aortoplasty of recurrent coarctations of the aorta.
Methods: This is a retrospective review of 1 institution's 27-year experience with surgical repair of recurrent aortic coarctation. A thorough chart review was performed of all pediatric patients undergoing surgical repair for recurrent aortic coarctation (n = 56) from January 1970 through July 1996.
Results: The vast majority of recoarctations were repaired with a prosthetic patch technique, with a greater than 96% success rate. No deaths or major complications occurred in the 56 patients. Although a direct comparison with balloon aortoplasty cannot be done, we have reviewed the data available in the literature and found higher complication rates and lower success rates than we obtained in our series.
Conclusions: 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.

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