ALTERNATIVE TECHNIQUES FOR SURGICAL-MANAGEMENT OF RECOARCTATION

Objective: To evaluate the different surgical options in patients with recoarctation and minimal collaterals. Methods: Thirty-three cases op erated on between January 1980 and January 1995 were reviewed. Initial repair was end-to-end anastomosis in 16 patients, subclavian artery a ortoplasty in 10, synthetic parch aortoplasty in 4 and bypass conduit in 3 patients. Age at reoperation was 7.5 +/- 5.2 years (1-17 years), Pressure gradient was 20-48 Torr (33 +/- 9). Upper extremity resting o r exercise systemic hypertension was present in all. In 18 patients re coarctation was repaired using subclavian artery aortoplasty (n = 15) or synthetic patch aortoplasty (n = 3); alone In 9; with temporary hep arinized bypass in 2, or in addition to placement of ascending aorta t o descending aorta conduit as a permanent bypass through a left thorac otomy in 9. In 13 patients a conduit was interposed between ascending aorta and descending aorta through a right thoracotomy. In one patient rc coarctation segment was patched on cardiopulmonary bypass through a midsternotomy. Results: There was no mortality or complications. All patients had no echocardiographic pressure gradients across recoarcta tion on 5 +/- 3.4 years follow-up. Persistent systemic hypertension fo llowing recoarctation repair was present iu 3/8 patients (37%) operate d on at age: greater than IO years, but has been resolved in all 25 pa tients less than 10 years of agr (P = 0.02). Conclusions: Use of ascen ding aorta to descending aorta conduit, either alone through a right t horacotomy, or as permanent bypass in combination with patching the re coarctation through a left thoracotomy provides safe and excellent rel ief of obstruction. (C) 1997 Elsevier Science B.V.