Comparison of polytetrafluoroethylene patch aortoplasty and end-to-end anastomosis for coarctation of the aorta.
OBJECTIVE
Although aneurysm formation and recoarctation after Dacron patch aortoplasty have been reported on extensively, less is known about these outcomes after polytetrafluoroethylene patch repair, which was compared with resection and end-to-end anastomosis in this study.


METHODS
Two hundred sixty-two children had surgical repair of coarctation of the aorta by means of either resection and end-to-end anastomosis (n = 137; mean age, 1.85 +/- 3.1 years) or polytetrafluoroethylene patch aortoplasty (n = 118; mean age, 1.09 +/- 1.9 years) during a 28-year period. Coarctation was isolated in 109 (41.6%), associated with ventricular septal defect in 77 (29.4%), and associated with complex intracardiac anomalies in 76 (29.0%) patients. Follow-up ranged from 2 days to 29.3 years (median, 11.9 years). Seven patients were lost to follow-up. Kaplan-Meier survival curves were estimated, and multivariable Cox regression analysis was performed for several outcome variables.


RESULTS
Mortality was 8.2% and was associated with intracardiac pathology in all cases. Recoarctation occurred in 53 patients, 23 after resection and anastomosis and 30 after patch repair, not differing statistically (P =.4, log-rank test). Aneurysm formation occurred in 8 patients after patch repair that included ridge resection in 7 of the 8 patients. Late hypertension occurred in less patients (n = 3) after resection and anastomosis than after patch repair (n = 8) (P <.03). Arch hypoplasia (P <.01) and age less than 1 month (P <.001) were found to be independent risk factors for recoarctation.


CONCLUSIONS
Polytetrafluoroethylene patch repair including coarctation ridge resection was found to be a risk factor for aneurysm formation and late hypertension. Arch hypoplasia and young age must be considered to predispose to recoarctation.
Walhout
Ronald J
RJ
Children's Heart Center, Department of Cardiology/Cardiac Surgery, Wilhelmina Children's Hospital UMC, University of Utrecht, 3501 CA Utrecht, the Netherlands.
Lekkerkerker
Jaco C
JC
Oron
Gordon H
GH
Hitchcock
Francois J
FJ
Meijboom
Erik J
EJ
Bennink
Ger B W E
GB
D000293:Adolescent; D000367:Age Factors; D000714:Anastomosis, Surgical; D017130:Angioplasty / Q000379:methods*; D001011:Aorta / Q000002:abnormalities* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery; D001017:Aortic Coarctation / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D007229:Infant Welfare; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D011138:Polytetrafluoroethylene / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene