Risk factors for recoarctation and results of reoperation: A 40-year review

Background. We analyzed a single institution 40-year experience with childr en that had coarctation repair to define risk factors for recoarctation and to evaluate the results of reoperation for recoarctation. Material and Met hods: Between 1957 and 1998, 271 patients had primary surgical repair of co arctation of the aorta. Techniques for primary repair included Gore-tex pat ch aortoplasty (PATCH; n = 118), resection with extended end-to-end anastom osis (RXEEA; n = 69), subclavian flap aortoplasty (SFA; n = 61), resection with simple end-to-end anastomosis (ETE; n = 18), resection and interpositi on graft (n = 4), and extraanatomic graft (n = 1). Techniques for recoarcta tion repair included PATCH, interposition graft, and extra-anatomic graft. Results: Median age at initial repair was 156 days. Major associated cardia c anomalies were present in 96 patients (35%). A hypoplastic aortic arch wa s present in 37 patients (14%). There were three early deaths (1%) and six late deaths (2%). One patient had paraplegia (0.4%). Recoarctation occurred in 29 patients (11%) and was most frequent with ETE and SFA repairs (33% a nd 20%, respectively). Multiple logistic regression analysis revealed ETE r epair (p = 0.0002), SFA repair (p = 0.049), and aortic arch hypoplasia (p = 0.0001) to be risk factors for recoarctation. Using PATCH as the covariate , the odds ratio to develop recoarctation was 3.5 for SFA, 17.2 for ETE, an d 15.2 for hypoplastic aortic arch. There was no mortality or paraplegia af ter recoarctation repair (n = 23). Six patients had seven balloon angioplas ties; two of these patients later required reoperation. Three patients requ ired a second reoperation for persistent coarctation. Conclusions: In our 4 0-year review, simple end-to-end anastomosis and subclavian flap repair had the highest incidence of recoarctation, especially when associated with ao rtic arch hypoplasia. We recommend resection with extended end-to-end anast omosis for repair of neonates and infants and Gore-tex patch aortoplasty fo r children over the age of 1 year. Surgical repair of recurrent coarctation is safe, effective, and has a low incidence of persistent coarctation.