Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.
Eur J Cardiothorac Surg. 2019 Dec 1;56(6):1178-1185. doi: 10.1093/ejcts/ezz259.
Coarctation of the aorta (CoA) is rarely diagnosed and treated in adults and nowadays mostly treated with percutaneous techniques. The objective of this study is to report the long-term outcomes and health-related quality of life in a unique cohort of patients treated with an open surgical repair for their primary adult CoA.
Ninety adult patients underwent primary surgical repair of CoA at our tertiary referral centre between 1961 and 2008 when the treatment strategy for adult CoA was exclusively surgical.
The median age at surgery was 24 years (interquartile range 20-36 years), and 39 patients (43%) were asymptomatic at presentation. CoA was located paraductally in most patients (64%), and bicuspid aortic valve was present in 39 (43%) patients. Surgical reconstruction of CoA with an end-to-end anastomosis was performed in majority of the patients (57%). Overall, in-hospital mortality occurred in 1 patient (1%). There was no in-hospital stroke, spinal cord ischaemia, renal replacement therapy or respiratory failure. The cumulative survival was 97.7%, 89.5%, 82.6%, 70.9% and 61.4% at 10, 20, 30, 40 and 50 years, respectively. Thirty-one patients (34%) required an additional cardiac surgery during follow-up. The majority of patients (77%) suffered from refractory hypertension even after decades of surgery. Compared with the matched Dutch population, patients reported a lower social functioning, mental health, vitality and general health with a higher body pain.
Patients with native adult CoA have low in-hospital morbidity and mortality when treated with an open surgical reconstruction. However, refractory hypertension and impaired quality of life remain important challenges during follow-up.
成人主动脉缩窄（CoA）很少被诊断和治疗，现在主要采用经皮技术进行治疗。本研究的目的是报告一组独特的成人 CoA 患者接受开放手术修复的长期结果和健康相关生活质量。
1961 年至 2008 年期间，在我们的三级转诊中心，90 例成年患者接受了原发性成人 CoA 的外科修复，当时成人 CoA 的治疗策略完全是手术。
手术时的中位年龄为 24 岁（四分位距 20-36 岁），39 例（43%）患者在就诊时无症状。大多数患者（64%）的 CoA 位于导管旁，39 例（43%）患者存在二叶式主动脉瓣。大多数患者（57%）接受了 CoA 的端端吻合术重建。总体而言，1 例患者（1%）住院期间死亡。无院内卒中、脊髓缺血、肾替代治疗或呼吸衰竭。10、20、30、40 和 50 年时的累积生存率分别为 97.7%、89.5%、82.6%、70.9%和 61.4%。31 例（34%）患者在随访期间需要进一步心脏手术。大多数患者（77%）即使在手术后几十年仍患有难治性高血压。与匹配的荷兰人群相比，患者报告的社会功能、心理健康、活力和一般健康状况较低，身体疼痛较高。
成人先天性 CoA 患者采用开放手术重建治疗，住院期间发病率和死亡率较低。然而，难治性高血压和生活质量受损仍然是随访中的重要挑战。
