The early and long-term results of surgery for coarcation of the aorta in the 1st year of life

Abstract

The cases of 110 infants less than 1 year of age, who had surgical repair for coarctation of the aorta between June 1974 and February 1988, were analysed. Three groups of patients were identified. In group 1 there were 39 patients with isolated coarctation. In group 2 there were 25 infants with additional ventricular septal defects (VSD), while in group 3 there were 46 infants with other associated congenital cardiac defects. Repair was performed using the subclavian flap aortoplasty (SFA) procedure in 83 patients, resection with end-to-end anastomosis (EEA) in 23, patch aortoplasty in 3 and Goretex tube bypass in 1. Twenty-eight patients had simultaneous pulmonary artery banding and one concomitant closure of the VSD. The overall early mortality rate was 8.2% (5.1% in group 1, 0% in group 2, and 15.2% in group 3). Age at operation (under 1 month, p = 0.04) and other associated cardiac anomalies (p = 0.03) increased early mortality significantly. There were 11 late deaths (10.8%) among 101 patients followed from 1 to 15 years (mean 5.3 years). Twelve patients underwent further surgery for recoarctation, eight of them within 11 months. A further 11 patients currently have a Doppler gradient across their coarctation site of more than 20 mmHg, but have not undergone further surgery to the coarctation repair site.

Influence of Associated Defects and Type of Surgery in Neonatal Aortic Coarctation

“…Our results of subclavian flap angioplasty in the first month of life, with an 8% restenosis rate, compares favorably with the reported incidence of restenosis after this technique. 12,13 We could not demonstrate a significant difference in the incidence of restenosis between subclavian flap angioplasty versus resection with extended end-to-end anastomosis (20%). The incidence of restenosis after subclavian flap angioplasty and resection with extended end-to-end anastomosis in recent times has frequently been reported as comparable in neonates.…”

A postoperative follow‐up study of infantile coarctation of the aorta

“…Very young age has been considered a risk factor for early death in patients undergoing CoA repair in infancy (4,24,25). In our material 17 of 26 patients had undergone surgery at less than 1 month of age.…”

“…The prognosis for infants with CoA has changed markedly in the past decade (4,11,12). The main problem in the long-term follow-up of CoA operated on during infancy is residual or recoarctation.…”

“…Coarctation of the aorta (CoA) presenting with cardiac failure in infancy requires urgent surgical intervention ( I , 2). In recent years several reports have shown improvement in outcome for patients operated on for CoA during infancy (3,4). Different surgical techniques have been used for correction of infantile CoA, such as resection and end-to-end anastomosis, aortoplasty and the subclavian flap technique.…”

A Review of Surgical and Endovascular Repair of Coarctation of the Aorta

“…In EEA, resection begins on the inferior portion of the aortic arch and extends to the descending aorta, below the attachment of the ductus arteriosus [31]. The right innominate artery, left common carotid, and left subclavian artery all remain in place and the extent of arch resection is dependent upon the surgeon's assessment of vessel hypoplasticity.…”