Behaviour of polyester grafts in adult patients with repaired coarctation of the aorta

Abstract

Whatever the technique used for surgical or endovascular repair of a coarctation of the aorta (CA), long-term complications might occur. Aneurysm formation after patch angioplasty is not uncommon and may lead to a life-threatening condition. Therefore, we were interested in the long-term results of different types of tube grafts, from which a lower degree of dilatation is expected. All patients, currently older than 16 years, who underwent (redo) surgery for CA, and in whom a tube graft was inserted, were selected from the database of congenital heart disease of our hospital. Follow-up data were collected by reviewing the patients' files. The degree of graft dilatation was calculated for each patient. Fifty-three patients (41 males, median age 33.1 years, Q1-Q3 29.9-40.2 years) could be included in the study, in which 20 (38%) 'Gelseal', 12 (23%) 'Gelsoft', 8 (15%) 'Gelweave', and 13 (24%) older types of grafts were used. Twenty patients underwent a primary repair and in all others a tube graft was implanted after a previous patch angioplasty. The median graft diameter (manufacturer size) at implantation was 20 mm (Q1-Q3 16-22 mm). The median follow-up time of the grafts was 13.1 years (Q1-Q3 9.0-17.2 years). The graft size increased to a median value of 26 mm (Q1-Q3 22-30 mm) (median 50% increase in diameter, range 0-271%, P < 0.0001). The diameter of six grafts remained unchanged during follow-up. Three deaths occurred, of whom two were cardiac-related. False aneurysms occurred in four patients, graft aneurysm in two, endarteritis in two, and graft stenosis in one. Nearly, all tube grafts dilated up to 50% of the manufacturer diameter during follow-up. Re-interventions were inevitable in more than 10 per cent of the cases, primarily because of (false) aneurysm formation. Our series illustrates that late complications are not uncommon, so that rigorous follow-up of these CA patients remains mandatory.