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Ann Thorac Surg 2000;70:1488-1489
© 2000 The Society of Thoracic Surgeons

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Discussion

Discussion

Discussion

DR CARL L. BACKER (Chicago, IL): I would like to congratulate Dr Bouchart and colleagues on an outstanding review of coarctation repair in adult patients. I also thank you for the advance copy of the manuscript. This series of 35 adults having coarctation repair with no mortality, no paraplegia, and no late deaths is truly excellent. I have several comments and questions.

My first comment is that this report confirms the importance of early repair of coarctation. In your series, one third of the patients remained hypertensive and of those who were normotensive at rest, a full one third were still hypertensive with exercise. It is the elimination of this hypertension that underlies the importance of early repair of coarctation and not delaying until the adult years.

My second comment is that this series helps establish a true gold standard for comparison of surgical outcomes in adult patients versus transcatheter techniques. Several recent series have documented "good" results with balloon dilatation of coarctation in older adolescents and adults. Some of these series have improved their results by the use of a balloon-expandable stent placed at the time of coarctation dilatation. Your surgical standard of no mortality, no paraplegia, and no . . . [Full Text of this Article]

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