title: Surgical strategy for aortic coarctation repair resulting in physiologic arm and leg blood pressures.
abstract: OBJECTIVE
  The goal of aortic coarctation repair is laminar aortic blood flow resulting in a negative or absent arm:leg blood pressure (BP) gradient. Despite satisfactory relief of coarctation, associated arch hypoplasia can result in residual obstruction and postoperative upper body hypertension.
  
  
  METHODS
  We devised a surgical strategy to create a tension-free anastomosis with a diameter as large as both the adjacent proximal and distal aorta using a radically extended end-to-end anastomosis via sternotomy and/or thoracotomy. Sternotomy is chosen when there is significant transverse arch hypoplasia defined as a distal transverse arch ≤ diameter of the left carotid artery, presence of a common brachiocephalic trunk, or coexisting intracardiac lesion requiring repair. Thoracotomy is used in all other cases.
  
  
  RESULTS
  From 2000 to 2008, 95 consecutive patients were repaired using this approach, 35 with sternotomy and 60 with thoracotomy. At a mean follow-up of 50 ± 23 months, mean systolic BP was 94 ± 10 mm Hg, and 84% of patients had no residual arm:leg BP gradient. Mean arm:leg BP gradient was not statistically different between groups (-8.5 ± 15 sternotomy and -7.0 ± 10 mm Hg thoracotomy, P= .7). With Doppler echocardiography, 96% of patients demonstrated normal early diastolic reversal of blood flow in the descending thoracic aorta.
  
  
  CONCLUSIONS
  For aortic coarctation repair in infancy, a strategy designed to directly address aortic arch hypoplasia results in excellent intermediate-term results with normal BP, physiologic arm:leg BP relationship, and near normal descending aortic blood flow velocities by Doppler.
authors: Pediatric Cardiac Consortium of Upstate New York; University of Rochester Strong Memorial Hospital, 601 Elmwood Ave., Rochester, NY 14642, USA. michael_swartz@urmc.rochester.edu
authors: Michael F
authors: MF
authors: Swartz
authors: Nader
authors: N
authors: Atallah-Yunes
authors: Cecilia
authors: C
authors: Meagher
authors: Matthew P
authors: MP
authors: Schiralli
authors: Jill
authors: J
authors: Cholette
authors: Joseph
authors: J
authors: Orie
authors: Francisco
authors: F
authors: Gensini
authors: Rae-Ellen W
authors: RE
authors: Kavey
authors: George M
authors: GM
authors: Alfieris
mesh_terms: D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001017:Aortic Coarctation / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D009518:New York; D012039:Regional Blood Flow; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*