Alternative techniques for surgical management of recoarctation.
OBJECTIVE
To evaluate the different surgical options in patients with recoarctation and minimal collaterals.


METHODS
Thirty-three cases operated on between January 1980 and January 1995 were reviewed. Initial repair was end-to-end anastomosis in 16 patients, subclavian artery aortoplasty in 10, synthetic patch aortoplasty in 4 and bypass conduit in 3 patients. Age at reoperation was 7.5 +/- 5.2 years (1-17 years). Pressure gradient was 20-48 Torr (33 +/- 9). Upper extremity resting or exercise systemic hypertension was present in all. In 18 patients recoarctation was repaired using subclavian artery aortoplasty (n = 15) or synthetic patch aortoplasty (n = 3); alone in 9, with temporary heparinized bypass in 2, or in addition to placement of ascending aorta to descending aorta conduit as a permanent bypass through a left thoracotomy in 9. In 13 patients a conduit was interposed between ascending aorta and descending aorta through a right thoracotomy. In one patient recoarctation segment was patched on cardiopulmonary bypass through a midsternotomy.


RESULTS
There was no mortality or complications. All patients had no echocardiographic pressure gradients across recoarctation on 5 +/- 3.4 years follow-up. Persistent systemic hypertension following recoarctation repair was present in 3/8 patients (37%) operated on at age greater than 10 years, but has been resolved in all 25 patients less than 10 years of age (P = 0.02).


CONCLUSIONS
Use of ascending aorta to descending aorta conduit, either alone through a right thoracotomy, or as permanent bypass in combination with patching the recoarctation through a left thoracotomy provides safe and excellent relief of obstruction.
Caspi
J
J
The Heart Institute for Children, Christ Medical Center, Oak Lawn, IL, USA. jcaspi@pol.net
Ilbawi
M N
MN
Milo
S
S
Bar-El
Y
Y
Roberson
D A
DA
Thilenius
O G
OG
Arcilla
R
R
D000293:Adolescent; D000714:Anastomosis, Surgical; D001011:Aorta / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D012008:Recurrence; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery*