Coarctation of the aorta: tailoring the surgical approach.
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.


METHODS
Retrospective study of consecutive children undergoing surgical repair of coarctation of the aorta.


METHODS
Walter C Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta.


METHODS
Children presenting with coarctation of the aorta between June 1993 and October 1996 (n = 42), treated by one surgeon.


METHODS
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%).


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.
Mullen
J C
JC
Division of Cardiothoracic Surgery, University of Alberta, Edmonton. jmullen@gpu.srv.ualberta.ca
Bentley
M J
MJ
Talwar
M K
MK
D000714:Anastomosis, Surgical / Q000379:methods; D017130:Angioplasty / Q000379:methods; D001017:Aortic Coarctation / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D013348:Subclavian Artery; D013524:Surgical Flaps