Abstract 12320: Long-Term Outcomes of Open and Endovascular Management of Adult Aortic Coarctation

Abstract

Objective: To compare outcomes of endovascular vs. surgical management of adult aortic coarctation (CoA). Methods: We performed a retrospective study of patients who underwent surgical vs. endovascular intervention for CoA during adulthood (age>16 years) at a single institution. Results: We identified 137 adult patients with coarctation of the aorta seen between 1975 - 2019. 18/137 (13%) required no intervention for their coarctation. While 23/137 (40%) had surgical procedures and 34/137 (60%) had endovascular procedures. Surgical procedures included extra-anatomic bypass (13/23), resection of coarctation segment with interposition graft (4/23), distal hemi-arch replacement (1/23) and total arch replacement (1/23). Endovascular interventions included balloon angioplasty alone in 2/34 patients and stenting in 32/34 patients. Median age at intervention was 38 years (IQR: 30-47) in the surgical group and 36 (30-47) in the endovascular group. Patient follow up time ranged from 0-45 years with a mean follow-up of 12 years as calculated from the first intervention for CoA during adulthood. Overall survival was 96% in the surgical group and 100% in the endovascular group. There was one post-operative transient ischemic attack in the surgical group and no post-procedural complications in the endovascular group. In a Kaplan Meier analysis of freedom from re-intervention during an overall follow-up period of 45 years, surgical intervention for CoA during adulthood was superior to endovascular treatment (p=0.008). Conclusions: Although long-term survival is similar, surgical intervention for adult CoA offers superior freedom from re-intervention than endovascular treatment (p=0.008).