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. DESIGN: Retrospective study of consecutive children undergoing surgical repair of coarctation of the aorta. SETT ING: Waiter C Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta. PATIENTS: Children presenting with coarctation of the aorta between June 1993 and October 1996 (n=42), treated by one su rgeon. INTERVENTIONS: Children had repair by one of three methods: sub clavian 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%). MAIN 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, on e; transverse arch repair, two; subclavian flap angioplasty, two) nece ssitating balloon dilation, one of whom (subclavian flap an gioplasty) eventually required end-to-end repair. Another child, who had a subcl avian flap angioplasty, underwent transverse arch repair at the time o f complete cardiac repair. There was one perioperative death in a chil d who was in extremis preoperatively and three late deaths in children with additional complex intracardiac anomalies. CONCLUSIONS: A flexib le surgical approach with avoidance of synthetic material and low thre shold for extended repair has yielded good early and intermediate term results.