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Does surgical correction of coarctation of the aorta in adults reduce established hypertension?

Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK

*Corresponding author. Department of Paediatric Cardiac Surgery, Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton, UK. Tel.: +44 2380 777222; fax: +44 2380 798508.

E-mail address: marcus.haw{at}suht.nhs.uk (M.P. Haw).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether surgical correction of coarctation of the aorta in adults (>16 years) results in reduction in established hypertension. Altogether 484 relevant papers were identified using the below mentioned search, 11 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that surgical repair of coarctation of the aorta in adult patients is superior to conservative management in the reduction of established hypertension, with one meta-analysis and several retrospective reviews reporting low morbidity and low risk of re-stenosis. The reduction in blood pressure postoperatively has been demonstrated consistently, with most patients reported as normotensive without medication and the remainder having reduced requirements for antihypertensive medications. In all the papers included here (except one), there was no early mortality and no procedure-related late mortality during mean follow-up ranging from 2 to 14 years. Thus, surgical correction of aortic coarctation is a relatively safe procedure.

Key Words: Coarctation of aorta; Cardiac surgery; Hypertension; Evidence based medicine

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eComment: Surgical treatment of coarctation in adult patients yields better long-term results with regard to hypertension but carries a substantial risk

Christian Schreiber and Alfred Hager
Interactive CardioVascular and Thoracic Surgery 2009 8: 127-128. [Full Text] [PDF]

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				C. Schreiber and A. Hager eComment: Surgical treatment of coarctation in adult patients yields better long-term results with regard to hypertension but carries a substantial risk Interactive CardioVascular and Thoracic Surgery, January 1, 2009; 8(1): 127 - 128. [Full Text] [PDF]