Coarctation of aorta in adults: a narrative review of surgical and endovascular management

Abstract

Coarctation of the aorta (CoA) accounts for 5–8% of all congenital heart diseases. Without correction, the mean life expectancy of patients with CoA is 35 years and 90% of those patients die before reaching the age of 50 years. The various treatment options include endovascular, surgery and hybrid procedures. The endovascular treatment includes simple balloon dilatation, stent placement, and stent-graft placement. Though endovascular approaches are gaining popularity, not all CoA are suitable for the procedure. It depends on the anatomy of the lesion, associated pathology and clinical condition of the patient. The surgical techniques include resection and end-to-end anastomosis, subclavian flap repair, prosthetic patch repair and prosthetic interposition tube graft. These open surgeries can be performed with or without the aid of cardiopulmonary bypass (CPB) depending on the anatomy and collateral circulation. When using CPB for the surgery it can be performed either in normothermic or hypothermic circulatory arrest (HCA) or selective right lung ventilation with partial CPB. Meticulous care is taken during surgery, as we can encounter a lot of collaterals, which when damaged can cause profuse bleeding. Further adult CoAs are complicated by intracardiac abnormalities. These patients are managed either in a single or two stages which included extraanatomic bypass or hybrid procedures. A multidisciplinary team (consisting of cardiothoracic surgeon, interventional radiologist, cardiologist, and anaesthetist) are required to manage the unique and complex problems that affect these patients. The current management options are reviewed.