Surgical correction of coarctation of the aorta: Influence of age on late results

Abstract

The influence of age at operation on long-term results was studied in three different age groups of patients with coarctation of the aorta. The groups consisted of 19 children, 19 younger adults, and 20 older adults: 5 to 15, 16 to 31, and 35 to 62 years of age, respectively, at operation. Four patients died early of postoperative complications. The surviving patients were followed up for a mean period of 28, 29, 15 years, respectively. Twelve patients had died during the follow-up period. Three of them died of unrelated diseases and nine died of cardiovascular complications. At follow-up, hypertension was diagnosed in only one patient operated upon in childhood (9%). The incidence of hypertension was significantly higher (46%) in patients operated upon at older ages. All of the patients operated upon in childhood were in Functional Class I (NYHA); 10 of 26 older patients were in Class II or III. All of the children had a normal heart size, whereas seven of 26 patients in the two older groups had cardiac enlargement. Six of these seven patients had aortic valvular disease. A peak systolic pressure difference of 20 mm Hg or more across the anastomosis was measured at catheterization in only two of 29 patients. Aortic valvular disease was diagnosed in 37% of patients operated upon in childhood, in 58% of the younger adults, and 45% of the older adults. In light of the high late mortality and morbidity rates, surgical repair should no longer be considered as curative. Patients with coarctation of the aorta should be operated upon before school age in order to prevent hypertension. All patients having coarctation repair must be followed up carefully in order to detect aortic valvular disease.