COARCTATION OF THE AORTA IN PATIENTS YOUNGER THAN 3 MONTHS - A CRITIQUE OF THE SUBCLAVIAN FLAP OPERATION

  • 1 January 1985
    • journal article
    • research article
    • Vol. 89  (1) , 128-135
Abstract
Unexpected and disappointing subclavian flap operation results promopted this analysis of coarctation repair in infants under 3 mo. A total of 134 patients underwent surgical repair since 1960 with 55 end-to-end anastomoses performed earlier in our experience (mean follow-up 5.0 yr) and 67 subclavian flap angioplasty operations more recently (mean follow-up 2.0 yr). The operative mortality was not significantly different (P = 0.3) between end-to-end anastomosis (29%) and subclavian flap angioplasty (19%), but it was significantly higher (P < 0.01) in the first wk of life (56%). Recurrent coarctation occurred in 16 cases, necessitating reoperation. The reoperation-free rates (with SE) at 5 yr for end-to-end anastomosis and subclavian flap angioplasty were 92% .+-. 5% and 75% .+-. 7%, (P = 0.01). Of 10 patients who had reoperation after angioplasty 8 had early recurrence with continued involution of the periductal tissues and growth of the posterior aortic ridge. Six patients who had recurrence after anastomosis demonstrated late anastomotic growth failure. The most common reoperation technique was patch aortoplasty (10 patients). The high incidence of early recurrence with subclavian flap angioplasty in infants under 3 mo. suggests end-to-end anastomosis as the choice procedure when applicable.

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