Coarctation of the Aorta

Open-heart Surgery for the Repair of Coarctation of the Aorta

Coarctation of the aorta is usually treated surgically by removing the obstruction. A surgical repair done in childhood may be outgrown and may need to be redone in adulthood.

Before surgery

Mayo Clinic patients who are good candidates for open-heart surgery meet with members of the specialized team that will assist in their care. They receive instructions to help prepare for the surgery. Information about eating, drinking and taking medications before the surgery is explained. Patients are encouraged to ask questions about the surgery and anything relating to their experience at Mayo Clinic.

Most patients are admitted to the hospital the morning of surgery.

During surgery

Generally, the time of surgery averages four hours, but each person is unique, and a range of three to six hours is common.

Patients are given a mild tranquilizer to help them relax before being taken into the operating room, where they receive a general anesthetic.

The heart is stopped for the surgery, and a heart-lung bypass machine oxygenates the blood and circulates it throughout the body during surgery. An incision is made through the breastbone (sternum) to reach the area of the coarctation. The defect is then repaired.

Once the procedure is completed, and the surgical team is satisfied that the heart is beating strongly, the heart-lung machine is disconnected. The chest incisions are then closed (sutured).

The sternum will knit back together in six to eight weeks and will be as strong as normal after it heals.

Immediately following surgery

When patients awake from anesthesia, they are generally groggy and somewhat disoriented. The area of the incisions may be sore. Pain medication is available and patients are encouraged to take it as needed.

Patients are in the cardiac intensive care unit, and then transferred to a standard hospital unit. Typically, once patients are in a standard unit, they are ambulatory (able to walk) while attached to a small heart monitor.

Patients are in the hospital an average of four to five days. Much of that time is spent waiting for the tissue swelling to decrease and to ensure that the defect has been effectively repaired. During the hospital stay, tests are conducted to assess and monitor the patient's condition. Blood pressure is closely monitored.

After leaving the hospital

In general, patients begin to feel better two to three weeks after surgery. During that time, patients are usually given aspirin or a prescription anticoagulant to reduce the risk of blood clot formation.

Full energy levels usually start to return in about three months. Most patients can expect to feel more tired than usual, and their stamina may not yet be completely normal. After six months, most patients are back to normal.

The decision about when to resume a full work schedule varies with the individual. For patients with physically demanding jobs, the recovery may take longer than three months.

Many patients have benefited from the structured workout of a cardiac rehabilitation program while recovering from surgery. The program starts with a walking schedule for the first six to eight weeks and progresses to more vigorous, supervised training.

Follow-up care

Generally, patients return to their local doctor a week after being discharged from the hospital and are examined to ensure that they are healing properly. Follow-up appointments with the cardiologist take place at six months to one year.

The Mayo Clinic staff works with the patient and the patient's local doctor and cardiologist to assist with a full and smooth recovery following surgery.

Surgery usually relieves the obstruction to the forward flow of blood throughout the body, but often hypertension (high blood pressure) will continue and require ongoing monitoring and treatment.

General narrowing throughout the aorta is often seen in people with a coarctation of the aorta, as is an abnormality in the structure of the arteries, so coarctation patients face a continued risk for arterial rupture, dissection (separation of the layers of tissue within the walls of the aorta) and stroke even after a successful surgical repair. Blood pressure control becomes critical in order to reduce this risk.

It is important for those who have had open-heart surgery to inform their doctor and dentist. Patients should take an antibiotic before any dental or surgical procedure, because bacteria can enter the bloodstream during these procedures and get into the heart. This could lead to a serious condition called bacterial endocarditis. Antibiotics can prevent bacterial endocarditis.

Complications

Major complications are rare, and with improvement in technology and surgical techniques, occurrences continue to decrease. However, every open-heart surgery entails some risk. Potential complications include infection, bleeding, stroke and heart attack.