Early and moderate long-term results of a new surgical technique for repair of aortic coarctation.
OBJECTIVE
From June 1987 to September 1995, 53 patients underwent a new technique of coarctation repair. This technique consists of complete mobilization of the left subclavian artery so that it can be pulled down as far as possible.


METHODS
After all the necessary clamping, the anterior wall of the aorta is incised longitudinally beginning on the anterior wall of the left subclavian artery and extending distally to the descending aorta 1-2 cm past the coarctation. The left subclavian artery is pulled down so that the proximal end of the incision can reach the distal end. Then, this longitudinal incision is sutured transversely with 5/0 or 6/0 polydioxanone and continuous technique, enlarging the coarctation site and also preserving the blood flow to the left upper limb. The ages of the patients ranged from 16 days to 20 years (mean 3.7 years). Thirty patients were younger than 1 year old. One patient (1.9%) died postoperatively due to persistent pulmonary hypertension.


RESULTS
There was no pressure gradient perioperatively through the coarctation site after the repair. The mean follow-up was 34.4 +/- 27.5 months (range 1-99 months). All patients but one were in class I effort capacity (NYHA). Doppler echocardiographic studies were performed in 45 patients postoperatively. There was no restenosis or aneurysm formation at the coarctation site and the mean pressure gradients were between 19.8 +/- 16.2 mmHg.


CONCLUSIONS
The authors experience indicates that this technique could be a good alternative to the subclavian flap aortoplasty because of the preservation of blood flow to the left arm.
Department of Cardiovascular Surgery, University of Istanbul, Turkey.
T
T
Sarioğlu
B
B
Kinoğlu
A
A
Sarioğlu
L
L
Saltik
Y
Y
Yalçinbaş
T
T
Yildön
R
R
Olga
A
A
Aytaç
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001017:Aortic Coarctation / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D013348:Subclavian Artery / Q000601:surgery; D013536:Suture Techniques; D016896:Treatment Outcome