PRIMARY REPAIR OF COARCTATION OF THE THORACIC AORTA BY PATCH GRAFT AORTOPLASTY - A 3 DECADE EXPERIENCE ACID FOLLOW-UP IN 60 PATIENTS

Objectives. The present report is a critical review on primary repair of aortic coarctation by patch aortoplasty on the basis of over 30 yea rs surgical experience. Methods. Since 1962, 60 patients (mean age 9.4 +/-4.8 years, range 2-25 years), affected by aortic coarctation, under went patch aortoplasty repair. During the operation protective guideli nes were adopted: additional external Dacron was placed around the rep aired site in cases of friable host tissue, the aortic ridge was not e xcised to leave the posterior aortic wall intact, and the patent ductu s arteriosus or ligamentum arteriosum was transected and sutured. Prop hylactic measures of neurologic sequelae were: dual pressure monitorin g, sequential aortic clamping, surgical shunt or left heart bypass ass ociated with moderate hypothermia when the distal aortic pressure was less than 50 mmHg. Results. No early deaths occurred. The overall surv ival rate was 92.77+/-4.04% at 31 years from surgery. Three late death s occurred. Pressure gradients across the patch ranged between 9 and 2 0 mmHg. Late aneurysm occurred in one patient (1.3%), 2 years after ba cterial endocarditis had developed on a biscuspid aortic valve. Conclu sions. Patch aortoplasty is an effective and safe surgical procedure f or primary repair of isthmic aortic coarctation when other surgical te chniques cannot be performed.