Repair of aortic coarctation in patients more than 50 years of age.

BACKGROUND

Most patients with uncorrected coarctation of the aorta die before reaching age 50 years. In those who survive, the beneficial effect of surgical repair on systolic hypertension has been questioned.

METHODS

Surgical repair of aortic coarctation was performed in 8 patients aged 51 to 73 years (mean, 58+/-9 years). Preoperative mean systolic pressure was 185+/-34 mm Hg and systolic gradient, 70+/-11 mm Hg. In addition, 3 patients had significant coronary artery disease. Severe calcification of the aortic arch and left subclavian artery was found in 3 patients. The surgical technique involved bypass of the coarctation with a Dacron tube graft (16 or 18 mm) in all patients. One patient underwent concomitant coronary artery bypass grafting.

RESULTS

There were no operative or late deaths during a mean follow-up of 4.3 years. Mean systolic blood pressure decreased significantly in the postoperative period to 128+/-16 mm Hg (p < 0.001). At the last visit, systolic blood pressure was a mean of 127+/-9 mm Hg. Five patients were not taking antihypertensive medication.

CONCLUSIONS

Surgical repair of aortic coarctation in patients more than 50 years of age with a Dacron tube bypass graft reduces systolic hypertension and the need of antihypertensive medication.