BACKGROUND: There is no consensus in the literature regarding the optimal method for repair of coarctation of the aorta in the adolescent and young adult. METHODS: We retrospectively reviewed operations in 45 patients treated between 1978 and 2003. RESULTS: From 1978 to 2001, there were 45 adolescents or adults between the ages of 11 and 53 years (mean 21, SD +/- 10) who underwent surgical correction. The perioperative mortality rate was 0% and the morbidity rate was 18%. All patients had improved blood pressure before discharge after a mean of 7 days, which ranged from 160/90 mm Hg to 90/50 mm Hg (mean 128/73 mm Hg, SD +/- 17/12 mm Hg). This was an average improvement of 35 mm Hg (SD +/- 26) compared with the preoperative pressure (p < 0.0005). Long-term results (defined as 5 years or more) were documented for 30 (71%) with a mean follow-up of 18.2 years (range, 67 to 293 months; SD +/- 70 months). At the time of last follow-up, the blood pressure was documented and averaged 122/73 mm Hg (SD +/- 11/10 mm Hg), which was a decrease of 36 mm Hg (SD +/- 29) compared with the preoperative pressure (p < 0.0005). Seventy-six percent of patients were on no medications for hypertension. None of the 30 patients available for long-term follow-up has required a second operation for recurrence. CONCLUSIONS: Surgical repair of coarctation in the adolescent and adult is safe and durable, with a high success rate in curing patients of hypertension and making them medication-free for life. The recurrence rate is low, and most patients will not require any further intervention.
BACKGROUND: There is no consensus in the literature regarding the optimal method for repair of coarctation of the aorta in the adolescent and young adult. METHODS: We retrospectively reviewed operations in 45 patients treated between 1978 and 2003. RESULTS: From 1978 to 2001, there were 45 adolescents or adults between the ages of 11 and 53 years (mean 21, SD +/- 10) who underwent surgical correction. The perioperative mortality rate was 0% and the morbidity rate was 18%. All patients had improved blood pressure before discharge after a mean of 7 days, which ranged from 160/90 mm Hg to 90/50 mm Hg (mean 128/73 mm Hg, SD +/- 17/12 mm Hg). This was an average improvement of 35 mm Hg (SD +/- 26) compared with the preoperative pressure (p < 0.0005). Long-term results (defined as 5 years or more) were documented for 30 (71%) with a mean follow-up of 18.2 years (range, 67 to 293 months; SD +/- 70 months). At the time of last follow-up, the blood pressure was documented and averaged 122/73 mm Hg (SD +/- 11/10 mm Hg), which was a decrease of 36 mm Hg (SD +/- 29) compared with the preoperative pressure (p < 0.0005). Seventy-six percent of patients were on no medications for hypertension. None of the 30 patients available for long-term follow-up has required a second operation for recurrence. CONCLUSIONS: Surgical repair of coarctation in the adolescent and adult is safe and durable, with a high success rate in curing patients of hypertension and making them medication-free for life. The recurrence rate is low, and most patients will not require any further intervention.