Reverse subclavian flap repair of hypoplastic transverse aorta in infancy

Background. Management of hypoplastic aortic arch associated with coarctati on in infancy can be challenging. Reverse subclavian flap aortoplasty plus coarctation resection offers simplicity without needing foreign material or cardiopulmonary bypass. Methods. Since 1988, 46 of 162 infants less than 3 months undergoing coarct ation repair had hypoplastic arch enlargement with reverse subclavian flap aortoplasty. Median age was 11 days; mean weight was 3.2 kg. Thirty-seven p atients (80%) had associated cardiac defects including single or multiple v entricular septal defects (14 infants), transposition of the great arteries (7), aortic or mitral stenosis (5), and complete atrioventricular septal d efect (5 infants). Twenty-eight patients had pulmonary artery banding; 2 ha d an arterial switch operation through a separate median sternotomy. Results. There were two hospital deaths: one 4 months postoperatively in a patient requiring a Norwood procedure the next day for underestimated left ventricular hypoplasia; the other of sepsis more than 1 month postoperative ly. On follow-up from 1 to 129 months (mean, 38 months), there were five re current obstructions: three at the coarctation site treated with balloon di latation and two at the arch site. Twenty-six children had their heart defe cts corrected with 29 subsequent operations including an arterial switch op eration for transposition of the great arteries/ ventricular septal defect (3 infants), relief of aortic or mitral stenosis +/- ventricular septal def ect closure (5), multiple ventricular septal defect closure (3), a bidirect ional Glenn (2), complete atrioventricular septal defect (2), and anomalous left coronary with ventricular septal defect repair (1 infant). Four child ren await debanding and ventricular septal defect closure or Glenn anastomo sis. There have been two late deaths (overall survival, 91%). Conclusions, Reverse subclavian flap aortoplasty is excellent for relief of arch hypoplasia and coarctation in infants with low recurrence rates and a cceptable operative and intermediate survival. (Ann Thorac Surg 2001;71:153 0-6) (C) 2001 by The Society of Thoracic Surgeons.