Repair of coarctation of the thoracic aorta by patch graft aortoplasty

Abstract

Patch graft aortoplasty, rather than resection of the coarctation segment plus end-to-end anastomosis, was utilized in 70 patients ranging from 2 days to 65 years in age. Associated defects were present in 84 per cent of the patients under the age of 2 years (Group I) and in 50 per cent of the patients ages 2 to 65 years (Group II). The mortality rate in Group I was 26 per cent. All 5 patients who died were under the age of 2 months, had severe pulmonary hypertension from associated cardiac defects, and died within 4 days after the operation. None of the patients between 2 months and 2 years of age died. In Group II the mortality rate was 4 per cent. Both patients who died had severe associated defects; no patient with simple coarctation died. In Group II, associated cardiac defects were concomitantly repaired with patch graft aortoplasty. There was no evidence of recurrence in the follow-up period up to 12 years following surgery, but in 1 patient there was a 20 mm. Hg gradient across the repair. One technical aspect essential for successful repair is the fashioning of a patch large enough so that the proximal and distal portions of the patch along with the coarcted segment do not result in subsequent obstruction. The advantages of avoiding a circular constricting anastomosis, retaining the posterior wall for further growth potential, and eliminating suture line tension are essential in repair of coarctation in infants. Lack of hemorrhage problems, adaptability to long coarcted segments, and the small degree of mobilization of the aorta required are other definitive advantages. The technique is recommended for more widespread usage and for routine repair of coarctation of the thoracic aorta.