MORE THAN 35 YEARS OF COARCTATION REPAIR - AN UNEXPECTED HIGH RELAPSERATE

Between 1953 and 1985, 109 consecutive patients (17% with isolated coa rctation) younger than 3 years of age underwent resection of aortic co arctation. These patients had nonelective operations because of conges tive heart failure or severe systemic hypertension not responding to m edical therapy. Special surgical techniques were used to lower the pre valence of restenosis. Hospital mortality was 32% (35 patients). Logis tic regression analysis proved that age at operation, pulmonary artery banding, and type of repair were independent predictors of hospital d eath. Late mortality occurred in 9 patients. Associated cardiac anomal ies were an independent prognostic factor for late mortality. The oper ation rate for recoarctation was low (5.8%). However, the follow-up st udy revealed that 30 patients (41%) had recoarctation. The Kaplan-Meie r estimate of recoarctation is 86% after 30 years' follow-up in patien ts undergoing classic end-to-end anastomosis with silk sutures (n = 48 ). None in the group with an ''extended'' anastomosis and polypropylen e sutures (n = 26) had recoarctation. The Cox analysis revealed age at operation under 6 months to be prognostic for recoarctation. Because of the shorter period of follow-up, the extended anastomosis with poly propylene sutures proved not to be a significant prognostic factor for recoarctation. In the late postoperative period (mean follow-up 16.7 years), blood pressure was elevated in 49% of the patients. At last fo llow-up 27 (36%) of the 74 survivors had aortic valve disease. Patient s operated on for coarctation of the aorta under the age of 3 years ne ed lifelong follow-up for detection of restenosis, hypertension, and v alvular disease. Reoperation-free rate is not a good criterion to judg e the outcome of operation for coarctation. Longer follow-up will be n eeded to investigate whether or not the use of the extended anastomosi s technique with polypropylene sutures lowers the prevalence of recoar ctation.