Because surgical repair for coarctation of the aorta has been performed since 1945, growing numbers of patients with repaired coarctation are reaching adulthood. Primary transcatheter intervention for coarctation emerged as an alternative to surgery after 1983, and it provides comparable relief of the aortic gradient with few complications at a cost of an increased need for reintervention and a higher risk of aneurysm after repair. Although short-term outcomes are good after coarctation repair, alterations of vascular form and function persist. Mortality is increased after coarctation repair compared with that in the general population, which is related to several predictable complications. Hypertension mediates much of the late morbidity with increased rates of stroke, coronary artery disease, and heart failure after coarctation repair. Prevalence of hypertension in patients with coarctation increases over time, with a majority of patients being affected by middle age. Other late complications include recoarctation, which can usually be addressed with percutaneous balloon dilation and stenting with covered stents. Aneurysms at the coarctation repair site and the ascending aorta require surveillance with imaging and timely treatment. Intracranial aneurysms occur 5 times more commonly in patients with coarctation than in the general population. Finally, bicuspid aortic valve disease, which is present in at least half of these patients, requires surveillance and ultimately becomes the most common reason for reoperation. Awareness, identification, and appropriate treatment of long-term complications after coarctation repair are paramount to reducing long-term morbidity and mortality.
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