Circulation, Vol 80, 840-845, Copyright © 1989 by American Heart Association
M Cohen, V Fuster, PM Steele, D Driscoll and DC McGoon
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)
ARTICLES
Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction
Department of Medicine, Mount Sinai School of Medicine, City University of New York, New York.
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