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Article

The Fate of the Aorta after Coarctation Repair: Open Surgical Replacement of Descending Aorta in a High-Volume Unit

by
Ezin Deniz
1,
Dmitry Bobylev
1,
Heike Krüger
1,
Jawad Salman
1,
Alina Zubarevich
1,
Andreas Martens
2,
Tim Kaufeld
1,
Bastian Schmack
1,
Alexander Weymann
1,
Arjang Ruhparwar
1,
Aron-Frederik Popov
1,† and
Florian Helms
1,*,†
1
Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
2
Clinic for Cardiac Surgery, University Clinic Oldenburg, 26133 Oldenburg, Germany
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2024, 13(18), 5345; https://doi.org/10.3390/jcm13185345
Submission received: 14 August 2024 / Revised: 5 September 2024 / Accepted: 9 September 2024 / Published: 10 September 2024
(This article belongs to the Special Issue Evolution of Aortic Surgery: Advancements, Challenges, and Patient Benefits)
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Abstract

Objectives: Complications after aortic coarctation repair are associated with high mortality and require surgical or endovascular reintervention. For patients unsuitable for endovascular therapies, reoperation remains the only therapeutic option. However, surgical experience and up-to-date follow-up data concerning this overall rare entity in the spectrum of aortic reoperations are still highly limited. Thus, the aim of this study was to analyze the short-term outcomes and long-term survival of patients undergoing surgical descending aorta repair after previous coarctation repair in a high-volume unit. Methods: We present a retrospective single-center analysis of 25 patients who underwent open descending aorta replacement after initial coarctation repair. The surgical history, concomitant cardiovascular malformations, and preoperative characteristics as well as postoperative complications and long-term survival were analyzed. Results: The mean age at operation was 45.4 ± 12.8 years. A proportion of 68% (n = 17) of the patients were male. The most common complication necessitating reoperation after coarctation repair was aneurysm formation (68%) and re-stenosis (16%). The average time between initial repair and reoperation was 26.3 ± 9.9 years. Technical success was achieved in all the operations, while recurrent nerve damage (24%) and bleeding requiring rethoracotomy (20%) were identified as the most common perioperative complications. The one-year mortality was 0% and the overall long-term survival was 88% at 15 years. Conclusions: Open surgical descending aorta replacement can be performed safely and with excellent survival outcomes even in the challenging subgroup of patients after previous coarctation repair. Thus, reoperation should be considered a feasible approach for patients who are unsuitable for endovascular therapies. Nonetheless, concomitant cardiovascular anomalies and frequent preoperations may complicate the redo operation in this patient population.
Keywords: descending aorta replacement; coarctation of the aorta; adult congenital heart disease descending aorta replacement; coarctation of the aorta; adult congenital heart disease

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MDPI and ACS Style

Deniz, E.; Bobylev, D.; Krüger, H.; Salman, J.; Zubarevich, A.; Martens, A.; Kaufeld, T.; Schmack, B.; Weymann, A.; Ruhparwar, A.; et al. The Fate of the Aorta after Coarctation Repair: Open Surgical Replacement of Descending Aorta in a High-Volume Unit. J. Clin. Med. 2024, 13, 5345. https://doi.org/10.3390/jcm13185345

AMA Style

Deniz E, Bobylev D, Krüger H, Salman J, Zubarevich A, Martens A, Kaufeld T, Schmack B, Weymann A, Ruhparwar A, et al. The Fate of the Aorta after Coarctation Repair: Open Surgical Replacement of Descending Aorta in a High-Volume Unit. Journal of Clinical Medicine. 2024; 13(18):5345. https://doi.org/10.3390/jcm13185345

Chicago/Turabian Style

Deniz, Ezin, Dmitry Bobylev, Heike Krüger, Jawad Salman, Alina Zubarevich, Andreas Martens, Tim Kaufeld, Bastian Schmack, Alexander Weymann, Arjang Ruhparwar, and et al. 2024. "The Fate of the Aorta after Coarctation Repair: Open Surgical Replacement of Descending Aorta in a High-Volume Unit" Journal of Clinical Medicine 13, no. 18: 5345. https://doi.org/10.3390/jcm13185345

APA Style

Deniz, E., Bobylev, D., Krüger, H., Salman, J., Zubarevich, A., Martens, A., Kaufeld, T., Schmack, B., Weymann, A., Ruhparwar, A., Popov, A.-F., & Helms, F. (2024). The Fate of the Aorta after Coarctation Repair: Open Surgical Replacement of Descending Aorta in a High-Volume Unit. Journal of Clinical Medicine, 13(18), 5345. https://doi.org/10.3390/jcm13185345

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