Changing Trends in the Surgical Treatment of Coarctation of the Aorta

Abstract

From 1974 through 1983, 107 patients 4 days to 27 years old underwent 115 operations for treatment of coarctation of the aorta. Thirty-two patients were infants (1 year old or younger), and 28 of them were newborns. All newborns were seen with congestive heart failure. Seventy-one patients were seen with hypertension. Associated anomalies were present in 72 patients (67%). Resection was performed in 48 patients, patch aortoplasty in 16, bypass of the coarcted segment in 15, and left subclavian artery flap angioplasty (LSAFA) in 36. Ligation of a patent ductus arteriosus was simultaneously performed in 28 patients and pulmonary artery banding, in 4. Follow-up was 6 months to 9.2 years. There was a significant difference in aortic cross-clamp time between 26 patients who had resection (37.9 ± 12.9 minutes) (mean ± standard deviation) and 32 patients who had LSAFA (22.9 ± 7.7 minutes) ( p < 0.05). Six patients died within thirty days after operation; 5 of them had resection, and 1 had bypass. Major postoperative complications included bleeding requiring exploration in 3 patients (2 after resection and 1 after LSAFA) and paraplegia in 1 patient after reoperation (resection) for recurrent coarctation 3 years after patch aortoplasty. Paradoxical hypertension was observed in 13 patients, and sustained systemic postoperative hypertension developed in 11 after effective repair of coarctation. There was no significant difference in early postoperative arm-leg pressure gradients between the types of operation or the various age groups. Among patients operated on in infancy, arm-leg gradients at latest follow-up were significantly lower in 11 patients after LSAFA (6.7 ± 9.4 mm Hg) than in 4 patients after resection (32 ± 27.1 mm Hg) ( p < 0.025). In older patients, no significant difference in late gradients was observed. Left subclavian artery flap angioplasty is effective and safe for the treatment of coarctation of the aorta in newborns and infants.