EARLY AND MODERATE LONG-TERM RESULTS OF A NEW SURGICAL TECHNIQUE FOR REPAIR OF AORTIC COARCTATION

Objective. From June 1987 to September 1995, 53 patients underwent a n ew technique of coarctation repair. This technique consists of complet e mobilization of the left subclavian artery so that it can be pulled down as far as possible.Method. After all the necessary clamping, the anterior wail of the aorta is incised longitudinally beginning on the anterior wall of the left subclavian artery and extending distally to the descending aorta 1-2 cm past the coarctation. The left subclavian artery is pulled down so that the proximal end of the incision can rea ch the distal end. Then, this longitudinal incision is sutured transve rsely with 5/0 or 6/0 polydioxanone and continuous technique, enlargin g the coarctation site and also preserving the blood flow to the left upper limb. The ages of the patients ranged from 16 days to 20 years ( mean 3.7 years). Thirty patients were younger than 1 year old. One pat ient (1.9%) died postoperatively due to persistent pulmonary hypertens ion. Results. There was no pressure gradient perioperatively through t he coarctation site after the repair. The mean follow-up was 34.4+/-27 .5 months (range 1-99 months). All patients but one were in class I ef fort capacity (NYHA). Doppler echocardiographic studies were performed in 45 patients postoperatively. There was no restenosis or aneurysm f ormation at the coarctation site and the mean pressure gradients were between 19.8+/-16.2 mmHg. Conclusion. The authors experience indicates that this technique could be a good alternative to the subclavian fla p aortoplasty because of the preservation of blood flow to the left ar m.