COARCTATION OF THE AORTA - REPAIR WITH POLYTETRAFLUOROETHYLENE PATCH AORTOPLASTY

Background The first successful surgical repair of coarctation of the aorta (CoAo) was performed in 1944, but during the years that followed a high incidence of recoarctation was seen, ranging from 20% to 86%. In response to that problem, the patch aortoplasty was introduced in 1 957; however, true aneurysms were found in the aortic wall opposite th e patch after Dacron patch aortoplasty, particularly when the coarctat ion ridge was excised. The purpose of our review was to evaluate the r esults of patch aortoplasty for CoAo using a relatively new material, polytetrafluoroethylene (PTFE), and an operative technique that does n ot involve resection of the coarctation ridge. Methods and Results Bet ween 1979 and 1993, 125 infants and children underwent PTFE patch aort oplasty for CoAo; 111 of the procedures were primary repairs, and 14 w ere reoperations. Diagnoses were isolated CoAo (96 patients), CoAo and ventricular septal defect (15 patients), and CoAo with complex intrac ardiac anomaly (14 patients). Patient age at the time of repair ranged from 4 days to 17 years (mean age, 5.1+/-4.5 years). There were no in stances of intraoperative mortality or paraplegia. There were 4 deaths from 10 to 40 days postoperatively, all in neonates (mean age, 33 day s) who received additional intracardiac procedures for complex associa ted anomalies. Follow-up has ranged from 6 months to 12.5 years (mean, 4.5+/-3.2 years). All children had postoperative chest roentgenograms , 80 (66%) patients have had a postoperative echocardiogram and 16 (13 %) a cardiac catheterization. One patient had successful repair of a f alse aneurysm 4 months postoperatively. No patient has developed a lat e true aneurysm. Of the patients <1 month of age at the time of CoAo r epair (12 patients), 6 patients had recurrent CoAo (gradient >20 mm Hg ) compared with only 4 recurrences in 97 patients >1 month of age at t he time of repair (P<.001). Conclusions For children >1 year of age, P TFE patch aortoplasty remains our procedure of choice for CoAo repair because of the low mortality rate, low recoarctation rate, and absence of late true aneurysms. We have stopped using this technique for infa nts <1 month of age because of the high recurrence rate.