Open, hybrid, and endovascular repair of recoarctation, aneurysm, and pseudoaneurysm after aortic coarctation repair.

OBJECTIVE

After aortic coarctation repair, patients may develop peri-anastomotic aneurysms or recoarctation requiring reintervention. We describe the spectrum of late coarctation repair-associated complications, repair strategies, and outcomes.

METHODS

From 1999 to 2023, 145 patients (mean age 38 ± 16 years, 66% male) underwent reintervention for recoarctation (74, 51%), aneurysm (28, 19%), pseudoaneurysm (19, 13%), and other indications (24, 16%) at a median of 29 years after initial repair. Survival and freedom from repeat reintervention were estimated with the Kaplan-Meier method. Median follow-up was 7.9 years.

RESULTS

Open and hybrid repair were performed in 38 and 18 cases, respectively, whereas most patients underwent endovascular repair with bare metal stents or covered stent-grafts (89, 61%). Open repairs involved 16 aorto-aortic bypasses, 12 interposition grafts, 6 conventional elephant trunk repairs, and 4 others. Hybrid repairs involved 13 frozen elephant trunks and 5 others. Operative mortality was 2.1%, whereas major adverse events including stroke (3, 2.3%), spinal cord injury (1, 0.7%), and acute kidney injury requiring dialysis (3, 2.3%) were uncommon. Average peak transcoarctation gradients decreased from 29 to 3 mm Hg postoperatively in the recoarctation group. Estimated freedom from repeat reintervention at 1, 5, 10, and 15 years was 87%, 80%, 75%, and 70%, respectively. Estimated survival at these intervals was 97%, 96%, 91%, and 84%, respectively.

CONCLUSIONS

Coarctation repair-associated complications are varied and complex, but can be managed with open, hybrid, and endovascular techniques tailored to the individual patient's pathology, morphology, and coexisting lesions with favorable outcomes at dedicated aortic centers.