SURGERY FOR COARCTATION OF THE AORTA IN INFANTS YOUNGER THAN 3 MONTHS- END-TO-END REPAIR VERSUS SUBCLAVIAN FLAP ANGIOPLASTY - IS EITHER OPERATION BETTER

Objective: Recurrent coarctation is a complication which is seen at a consistent rate following all types of repair for coarctation of the a orta. Particularly disappointing late results are reported in younger infants, under 3 months of age. This retrospective analysis was undert aken to compare the outcomes on late follow-up between subclavian flap angioplasty and resection and end-to-end repair, in this age group. M ethods: Over a 12-year period, between 1982 and 1994, 86 infants under 3 months of age underwent surgical repair of coarctation (39 resectio ns and end-to-end repair, and 47 subclavian flap angioplasty procedure s). Operative mortality was not significantly different (P = 0.6) betw een resection and end-to-end repair (5.1%) and subclavian flap angiopl asty (8.5%). All operative deaths (six patients) were in infants with associated ventricular septal defects. The mean follow-up for all pati ents was 7.95 years +/- 4.10 (range 0-14.5 years). The 5-year survival for resection and end-to-end repair was 87 +/- 5%, compared to 75 +/- 7% for subclavian flap angioplasty (P = 0.2), Results: Recurrent coar ctation occurred in nine patients who needed reoperation. The reoperat ion-free rates at both 5 and 10 years for resection and end-to-end ana stomosis, and subclavian flap repair were 86 +/- 6% and 90 +/- 5%, res pectively. The recurrence in the resection and end-to-end anastomosis group were due to constrictive scarring at the anastomosis, whereas pe riductal tissue and growth of posterior aortic ridge caused recurrence in the subclavian flap angioplasty group. There were no deaths during reoperation for recurrence. Conclusions: Both procedures are extremel y effective for coarctation repair in young infants and run a similar risk of recurrence, which are due to completely different mechanisms. The surgeon's expertise is the major determinant of outcome. (C) 1998 Elsevier Science B.V. All rights reserved.