COMPLICATIONS FOLLOWING REPARATIVE SURGERY FOR AORTIC COARCTATION OR INTERRUPTED AORTIC-ARCH

Repair of aortic coarctation or interrupted aortic arch continues to b e associated with major long-term morbidity. Thus, we conducted a revi ew of 87 consecutive patients who underwent aortic arch repairs, focus ing particular attention on the complications that developed. A two-st age strategy was employed if cardiac lesions were associated, The medi an age at surgery was 1.5 months with a range of 32h to 56 years. The aortic arch was repaired using end-to-end anastomosis, subclavian flap aortoplasty, subclavian arterial turning-down aortoplasty, patch aort oplasty, tube graft interposition, or other methods, There were 10 pat ients who died soon after repair, and all of whom had complex cardiac anomalies. Of the remaining 77 patients, 8 developed recurrent stenosi s. These 8 patients were all similar in age, being under 3 months old, and weighing 4kg or less. A multivariable analysis of the infants ide ntified interrupted aortic arch as an independent risk factor for the development of this complication,vith an odds ratio of 6.45. Complicat ions following prosthesis-free techniques were similar in prevalence a nd timing. All reinterventions were mortality-free, but catheter dilat ion and patch aortoplasty were not always successful. Three extraanato mic bypasses were successfully performed, and one adult who had underg one a previous graft and pseudoaneurysm operation was successfully tre ated with an extraanatomic bypass. These findings led us to conclude t hat the initial repair should be performed without a prosthesis, and t hat reintervention for stenosis should combine catheter dilation and e xtraanatomic bypass.