Coarctation of the aorta: tailoring the surgical approach.

ABSTRACT

OBJECTIVE: To employ a flexible approach for repairing coarctation of the aorta in an attempt to minimize residual coarctation and avoid the use of synthetic material. DESIGN: Retrospective study of consecutive children undergoing surgical repair of coarctation of the aorta. SETTING: Walter C Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta. PATIENTS Children presenting with coarctation of the aorta between June 1993 and October 1996 (n = 42), treated by one surgeon. INTERVENTIONS: Children had repair by one of three methods: subclavian flap angioplasty for discrete juxtaductal coarctation, 17 (40%); resection and end-to-end anastomosis, 13 (31%); and resection with extended transverse arch repair, 12 (29%). MAIN RESULTS: Follow-up was 22 +/- 2 months. The preoperative mean arm-leg gradient was 23 +/- 3 mmHg and postoperatively was 4 +/- 2 mmHg (P < 0.001). In late follow-up, five children developed a significant gradient (end-to-end anastomosis, one; transverse arch repair, two; subclavian flap angioplasty, two) necessitating balloon dilation, one of whom (subclavian flap angioplasty) eventually required end-to-end repair. Another child, who had a subclavian flap angioplasty, underwent transverse arch repair at the time of complete cardiac repair. There was one perioperative death in a child who was in extremis preoperatively and three late deaths in children with additional complex intracardiac anomalies. CONCLUSIONS: A flexible surgical approach with avoidance of synthetic material and low threshold for extended repair has yielded good early and intermediate term results.