SURGERY FOR COARCTATION OF THE AORTA IN INFANTS YOUNGER THAN 3 MONTHS- END-TO-END REPAIR VERSUS SUBCLAVIAN FLAP ANGIOPLASTY - IS EITHER OPERATION BETTER
A. Cobanoglu et al., SURGERY FOR COARCTATION OF THE AORTA IN INFANTS YOUNGER THAN 3 MONTHS- END-TO-END REPAIR VERSUS SUBCLAVIAN FLAP ANGIOPLASTY - IS EITHER OPERATION BETTER, European journal of cardio-thoracic surgery, 14(1), 1998, pp. 19-25
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.