Role of surgery in the management of the adult patient with coarctation of the aorta.

Adult patients with coarctation of the aorta have a range of clinical presentations. These include the presence of additional cardiovascular anomalies (predominantly aortic valve abnormality) and presentation with complications after coarctation repair in childhood (such as recurrent coarctation or aneurysm formation). Developments in endovascular technology over the past decade may potentially reduce the morbidity from open surgical repair. However, some cases are unsuitable for endovascular repair and open surgical techniques continue to play a part in the management of these patients. The number of adult patients with coarctation is very small and a trial comparing surgical and endovascular repair techniques would be difficult to arrange. A multidisciplinary team (consisting of cardiothoracic surgeon, interventional radiologist, cardiologist, and anaesthetist) is best equipped to manage the unique and complex problems that affect these patients. The current surgical options and factors governing the choice of approach are reviewed.