SURGICAL-TREATMENT OF AORTIC COARCTATION IN INFANTS YOUNGER THAN 3 MONTHS - 1985 TO 1990 - SUCCESS OF EXTENDED END-TO-END ARCH AORTOPLASTY

There remains controversy regarding the appropriate surgical treatment of coarctation of the aorta in infants. In 1985 we introduced the ext ended end-to-end repair into our practice and now wish to present a re view of our recent experience. One hundred fifty-one infants younger t han 3 months of age underwent repair of coarctation between 1985 and 1 990. In 25% and 33% of the patients, there was hypoplasia of the isthm us and of the transverse arch, respectively. Surgical procedures were as follows: subclavian flap angioplasty in 15 patients, resection with a traditional end-to-end anastomosis in 43, and resection with an ext ended end-to-end anastomosis into the arch in 77. In 30 patients, the extension was proximal to the origin of the left carotid artery (radic ally extended end-to-end anastomosis). Other procedures were used in 1 6 patients. Mortality (13 early and 12 late deaths) was related on mul tivariate analysis to the presence of an associated major heart defect , preoperative resuscitation, and direct postoperative gradient over t he arch. This immediate postoperative gradient was significantly lower after both extended and radically extended end-to-end anastomosis if there was a hypoplastic isthmus, and after radically extended end-to-e nd anastomosis if the transverse arch was hypoplastic. Actuarial freed om from recoarctation at 4 years was 57% (confidence limits 28% to 78% ) after subclavian flap angioplasty, 77% (confidence limits 60% to 87% ) after end-to-end anastomosis, 83% (confidence limits 66% to 92%) aft er extended end-to-end anastomosis and 96% (confidence limits 77% to 1 00%) after radically extended end-to-end anastomosis. We conclude that the extended end-to-end anastomosis and radical end-to-end anastomosi s appear to offer the best prognosis for all infants with coarctation. The technique can be applied successfully to almost all types of arch anomalies.