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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

German Heart Center Munich, Technical University Munich, 80636 Munich, Germany

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

We have read with interest the recent contribution of Vohra et al. on whether surgical correction of a coarctation of the aorta in adults (>16 years) results in reduction in established hypertension [1]. We wish to comment on some of the mentioned issues.

From the 11 papers representing best evidence to answer the raised question our institutional results were kindly mentioned [2]. However, only 68 patients of the reported 273 were 16 years or older at surgery. Even though we reported an overall mortality of 5%, it is of note that one third of the deaths accounted to neonates. Since introduction of prostaglandin no early mortality occurred [3]. Interestingly, our long-term survival data [2] compare to data published in 1970 [4] – Campbell even mentioned natural history of coarctation.

In our mind there is an ongoing confusion between hypertension and restenosis. Hypertension is not neccessarily linked to stenosis/restenosis. The pathophysiology seems much more complex, i.e. impairment of elastic properties of the aorta – surgical correction of any coarctation does not always resolve the inborn pathology [5]. Nevertheless, if coarctation with a systolic blood pressure gradient >20 mmHg is present, it should be considered as the main reason for the existing arterial hypertension.

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1. Vohra HA, Adamson L, Haw MP. Does surgical correction of coarctation of the aorta in adults reduce established hypertension? Interact CardioVasc Thorac Surg 2009;8:123–128.[Abstract/Free Full Text]
2. Hager A, Kanz S, Kaemmerer H, Schreiber C, Hess J. Coarctation long-term assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material. J Thorac Cardiovasc Surg 2007;134:738–745.[Abstract/Free Full Text]
3. Hager A, Schreiber C, Nutzl S, Hess J. Mortality and restenosis rate of surgical coarctation repair in infancy: a study of 191 patients. Cardiology 2008;112:36–41.[Medline]
4. Campbell M. Natural history of coarctation of the aorta. Br Heart J 1970;32:633–640.[Abstract/Free Full Text]
5. Vogt M, Kühn A, Baumgartner D, Baumgartner C, Busch R, Kostolny M, Hess J. Impaired elastic properties of the ascending aorta in newborns before and early after successful coarctation repair: proof of a systemic vascular disease of the prestenotic arteries? Circulation 2005;111:3269–3273.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Christian Schreiber Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schreiber, C. Articles by Hager, A. Search for Related Content PubMed PubMed Citation Articles by Schreiber, C. Articles by Hager, A. Related Collections Related Article