Isolated operative repair of coarctation of the aorta resulted in estimated survival of 91% at 10 years and 84% at 20 years, with age at initial repair being the strongest predictor of survival.
Cohort (n=646)
No
What are the long-term outcomes and predictors of survival after surgical correction of coarctation of the aorta?
Surgical repair of aortic coarctation should be performed early (by age 1 year) to optimize long-term survival, as older age at repair and higher postoperative systolic blood pressure independently predict worse survival.
The long-term clinical course was studied in 646 patients, who underwent isolated operative repair of coarctation of the aorta at the Mayo Clinic from 1946 to 1981. There were 17 perioperative deaths, and 58 patients were lost to follow-up. Of the 571 patients with long-term follow-up, 11% required subsequent cardiovascular surgery, and 25% developed hypertension. There were 87 late deaths. The mean age at death was 38 years (range, 0-67 years). Estimated survival analysis revealed 91% of patients alive at 10, 84% at 20, and 72% at 30 years after operative repair. The most common cause of late death was coronary artery disease in 32 patients, followed by sudden death, heart failure, cerebrovascular accidents, and ruptured aortic aneurysm. Age, sex, and postoperative systolic blood pressure were found to be independently predictive of survival. For patients less than 14 years of age at the time of initial coarctectomy, survival to 20 years was 91%, and for patients 14 years or older at the time of operation, survival was 79%. The best survivorship was observed in patients operated on at 9 years of age or less. The higher the postoperative systolic pressure, the higher the probability of death. This study has the largest population undergoing repair of coarctation of the aorta with a median follow-up of as long as 20 years. Four main points emerged. 1) Age at the time of initial repair is the most important predictor of long-term survival. Surgery should be offered to patients after age 1 year or sooner if hypertension is severe. 2) Coronary artery disease is the most common cause of late death.(ABSTRACT TRUNCATED AT 250 WORDS)
Cohen et al. (Sun,) conducted a cohort in Coarctation of the aorta (n=646). Isolated operative repair of coarctation of the aorta was evaluated on Long-term survival. Isolated operative repair of coarctation of the aorta resulted in estimated survival of 91% at 10 years and 84% at 20 years, with age at initial repair being the strongest predictor of survival.