Hypertension after coarctation repair—a systematic review

Abstract

Background: Coarctation of the Aorta (CoA) leads to increased morbidity and mortality later in life despite early surgical or percutaneous treatment. Many long-term complications are related to hypertension (HT) which is a common finding late after coarctation repair.Methods: A systematic Review was performed including articles published between February 2012 to December 2020. Systematic searches were conducted on PubMed and the Cochrane Controlled Trials Register to look for studies on HT after aortic CoA-repair. PRISMA guidelines were used.Results: In this systematic review on HT after CoA Repair the mean prevalence of HT was 47.3% (20-70%). A progressive character was of the HT was found, furthermore if only studies are included with 24 h blood pressure (BP) recording in addition to standard BP measurements, the incidence of HT rose to 57.8%. Discussion: Most clinical studies look at complications, mortality rate and residual pressure gradient rather than correlating hemodynamic indices with long-term outcome. Although HT is commonly based in measurement of peripheral BP, it has been shown that peripheral BP in CoA patients has a poor correlation with central aortic pressure. Central aortic hemodynamics are significantly altered in patients with repaired CoA, which can now adequately be investigated non-invasively. At the present time there are no studies linking long-term outcome with abnormal central hemodynamics.

Long‐term follow‐up after endovascular treatment of aortic coarctation with bare and covered Cheatham platinum stents

“…Residual arterial hypertension was present at last follow‐up in 53/158 patients (33.5%), which corresponds to findings of other investigators 25,26 . Suggested underlying pathomechanisms for residual arterial hypertension are abnormal vascular biomechanics, such as increased stiffness of the ascending aorta causing interference with the Windkessel effect, and impaired ventricular‐arterial coupling 25,26 .…”

“…Residual arterial hypertension was present at last follow-up in 53/158 patients (33.5%), which corresponds to findings of other investigators. 25,26 Suggested underlying pathomechanisms for residual arterial hypertension are abnormal vascular biomechanics, such as increased stiffness of the ascending aorta causing interference with the Windkessel effect, and impaired ventricular-arterial coupling. 25,26 The high number of patients with residual arterial hypertension despite sufficient obstruction relief and antihypertensive medication underlines aortic coarctation to be a systemic arterial disease with the indespensible need for constant follow-up and consequent medical and interventional treatment.…”

SCUBA Diving in Adult Congenital Heart Disease

“…After successful aortic coarctation repair, numerous patients remain hypertensive, with the associated long-term detrimental cardiac effects, such as diastolic dysfunction and left ventricular hypertrophy [ 53 ]. These factors should be considered when evaluating a coarctation patient.…”

Coarctation of the Aorta: Modern Paradigms Across the Lifespan

“…Hypertension is the most common long-term complication even after complete relief of CoA, occurring up to 80% of patients 25 years after repair. 2,31,43,62 This increased burden of hypertension is associated with decreased survival in adults with repaired CoA. 45,47 Complex mechanisms lead most commonly to systolic hypertension, although diastolic hypertension is also seen.…”