Aris A, Subirana M T, Ferrés P, Torner-Soler M
Department of Cardiology and Cardiac Surgery, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
Ann Thorac Surg. 1999 May;67(5):1376-9. doi: 10.1016/s0003-4975(99)00266-0.
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.
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.
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.
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.
大多数未经矫正的主动脉缩窄患者在50岁前死亡。在存活的患者中，手术修复对收缩期高血压的有益作用受到质疑。
对8例年龄在51至73岁（平均58±9岁）的患者进行了主动脉缩窄手术修复。术前平均收缩压为185±34 mmHg，收缩期压差为70±11 mmHg。此外，3例患者有严重冠状动脉疾病。3例患者发现主动脉弓和左锁骨下动脉严重钙化。所有患者的手术技术均采用涤纶人工血管（16或18 mm）绕过缩窄段。1例患者同时接受了冠状动脉旁路移植术。
平均随访4.3年期间无手术或晚期死亡病例。术后平均收缩压显著下降至128±16 mmHg（p < 0.001）。在最后一次随访时，收缩压平均为127±9 mmHg。5例患者未服用抗高血压药物。
采用涤纶人工血管旁路移植术对50岁以上的主动脉缩窄患者进行手术修复可降低收缩期高血压并减少抗高血压药物的使用。
