Operation for mid-arch coarctation

Background. Coarctation occurring within the aortic arch is rare and may pr esent difficulties during surgical repair. We describe the operative techni que and outcome in 6 patients with this unusual anomaly. Methods. Five patients had antegrade perfusion with circulatory arrest. Thr ee patients with presubclavian narrowing (one presenting with type B dissec tion) were operated through extended left thoracotomy. Two-precarotid and p aracarotid lesions were approached through a median sternotomy. All patient s were perfused antegradely from the ascending aorta and operated with hypo thermic circulatory arrest. One patient who had a complex presubclavian coa rctation after two previous repairs received an ascending aorta to abdomina l aorta bypass graft without cardiopulmonary bypass. Results. All patients survived operation and are well at a mean follow-up o f 3.3 years after the procedure. None had cerebral problems or spinal cord injury. Renal function was unchanged. The mean (+/- standard error of the m ean) resting gradient across the coarctation decreased from 42 +/- 4.0 mm H g to 6 +/- 1.2 mm Hg (p = 0.0004). Conclusions. Hypothermic circulatory arrest using antegrade ascending aorti c perfusion allows safe and effective repair of mid-arch coarctation. Compl icated reoperations can be managed safely using ascending-to-abdominal aort ic bypass. (Ann Thorac Surg 1999;67:1356-90) (C) 1999 by The Society of Tho racic Surgeons.