Primary operative repair of coarctation of the aorta in adults consists of either end-to-end anastomosis (usually the preferred method for initial repair), interposition graft, patch aortoplasty, or arch augmentation. In this case, because of the length of the narrowing, an end-to-end tubular graft is a safer long-term solution than a patch aortoplasty. The risk of aneurysm in the wall opposite the patch is very high 15 to 20 years after the operation. Aneurysms with end-to-end grafts do occur, but rarely. The mortality associated with surgical repair is approximately 1%. The incidence of complications is approximately 2%. The most significant morbidity from surgical repair of coarctation is spinal cord ischemia that results in postoperative motor impairment. Patch repair has resulted in an appreciable increase in recoarctation and development of false aneurysms compared with end-to-end anastomosis. The rate of recoarctation after a patch repair may be as high as 30% and aneurysm formation up to 35% with long-term follow-up.3
Other surgical risks are recurrent laryngeal nerve palsy, phrenic nerve injury, and rebound hypertension in the early postoperative phase. Collateral circulation increases with age. Although collateral vessels provide perfusion to the lower extremities and to the spinal cord during cross clamping and repair, the vessels are fragile and a hazard for blood loss requiring care during the initial incision and mobilization of the aortic segment. The operation is usually followed by an approximate 1-week hospital stay, and postoperative rehabilitation is necessary. The presence of a painful lateral thoracotomy and large scar may be an issue.