High incidence of aneurysm formation following patch plasty repair of coarctation

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Abstract
Repair of aortic coarctation was performed in 152 adolescent and adultpatients (mean age 28.5 years, range 14-67 years). Ninety patients weretreated with patch plasty, 33 with end-to-end anastomosis, 18 withinterposition of a tubular graft, 6 with prosthetic bypass and 5 withdirect plasty. There were two (1.3%) early and ten (6.6%) late deaths after2.9 to 11.8 (mean 6.6) years. Of the remaining 140 patients, 129 (92.1%)were reexamined with computed tomography and angiography after 1.5 to 17.2(mean 9.1) years postoperatively. In 27 patients (35.1%) of the patchplasty group significant dilatation at the operative site was observed andreoperation for aneurysm formation was required in 15 patients (19.5%).Resection of the intimal crest did not increase the probability of aneurysmformation, whereas Dacron as patch material and late hypertension had asignificant influence. Six of the ten late deaths occurred in the patchplasty group. Rupture of an aneurysm at the operative site was proved intwo of these patients, and three patients died suddenly for unknownreasons. In the other groups significant dilatation was observed in 13patients and 3 local aneurysms required reoperation (2 after end-to-endanastomosis and 1 after direct plasty). We conclude that patch plastyrepair of coarctation should be abandoned in adults. End-to-end anastomosisis advisable only if possible without excessive tension. Reoperation withinterposition of a tubular graft on left heart bypass proved to be a safemethod.

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