Benefits of surgical repair of coarctation of the aorta in patients older than 50 years

Background. Most patients with unrepaired coarctation of the aorta die before the age of 50 years. In patients who present at an older age, the indications for surgical treatment are controversial because the benefits of operating are unclear. Methods. At follow-up investigation from 0.5 to 11.5 yea...

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Bibliographic Details
Published in:	The Annals of thoracic surgery Vol. 72; no. 6; pp. 2060 - 2064
Main Authors:	Bauer, Matthias, Alexi-Meskishvili, Vladimir V, Bauer, Ulrike, Alfaouri, Diab, Lange, Peter E, Hetzer, Roland
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-12-2001 Elsevier Science
Subjects:	Antihypertensive Agents - administration & dosage Aortic Coarctation - diagnosis Aortic Coarctation - physiopathology Aortic Coarctation - surgery Biological and medical sciences Blood Pressure - drug effects Blood Pressure - physiology Blood Vessel Prosthesis Implantation Exercise Test Female Follow-Up Studies Humans Male Medical sciences Middle Aged Postoperative Complications - diagnosis Postoperative Complications - physiopathology Subclavian Artery - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels 20 Vascular disease Human Interest Plasty Aortic coarctation Middle age Treatment Malformation Surgery Cardiovascular disease Congenital disease Aortic disease
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Summary:	Background. Most patients with unrepaired coarctation of the aorta die before the age of 50 years. In patients who present at an older age, the indications for surgical treatment are controversial because the benefits of operating are unclear. Methods. At follow-up investigation from 0.5 to 11.5 years (mean, 4 years) after primary surgical correction of coarctation in 15 patients aged 50 to 63 years (mean, 54 years), we analyzed the preoperative and postoperative complications, symptoms, need for antihypertensive drugs, and blood pressure at rest and during exercise. Results. Preoperatively no patient had normal blood pressure at rest despite combined antihypertensive medication. There was no significant mortality or morbidity after repair. At follow-up examination only 3 patients had at rest mild hypertension, the other 12 patients were normotensive. Of the 11 tested patients, 8 displayed systolic arterial hypertension during exercise. Conclusions. Surgical correction of coarctation can be performed after the age of 50 years with low surgical risk. Operation reduces systolic hypertension at rest and permits more effective medical treatment. Despite persistence of the hypertension during exercise, symptomatic improvement occurs in most patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0003-4975 1552-6259
DOI:	10.1016/S0003-4975(01)03094-6