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Ann Thorac Surg 1989;48:496-502
© 1989 The Society of Thoracic Surgeons

Articles

Appraisal of Resection and End-to-End Anastomosis for Repair of Coarctation of the Aorta in Infancy: Preference for Resection

Jacques A.M. van Son, MD*, Otto Daniëls, MD, Josef G. Vincent, MD, Henk J.J. van Lier, MSc, Leon K. Lacquet, MD

Departments of Thoracic and Cardiac Surgery, Pediatric Cardiology, and Statistical Consultation, Academic Hospital Nijmegen, Nijmegen, the Netherlands

Accepted for publication March 30, 1989.

* Address reprint requests to Dr van Son, Department of Thoracic and Cardiac Surgery, Academic Hospital Nijmegen, PO Box 9101, 6500 HB Nijmegen, the Netherlands

Between 1973 and 1987, 70 consecutive infants underwent repair of coarctation of the aorta. Age at operation was 80.0 ± 77 days (mean ± standard deviation); mean weight was 3.0 ± 0.5 kg. Isolated coarctation was present in 25 patients (group 1); in 19 patients coarctation existed in association with ventricular septal defect (group 2); and in 26 patients coarctation was associated with major intracardiac defects (group 3). Subclavian flap angioplasty was performed in 19 patients and resection and end-to-end anastomosis in 51 patients. Hospital mortality was not significantly different between subclavian flap angioplasty (11%) and resection and end-to-end anastomosis (24%). Freedom from reintervention for recoarctation after 5 years was 87% in the subclavian flap angioplasty group and 95% in the group having resection and end-to-end anastomosis. Actuarial survival at 5 years was 100% for group 1, 73% for group 2, and 28% for group 3. In the subclavian flap angioplasty group, we observed detrimental effects of the sacrifice of the left subclavian artery: 1 patient had a 2.5-cm shortening of the left upper arm, and 5 others complained of claudication in the left upper limb during strenuous exercise. As no major advantage in terms of mortality and recoarctation to either technique of coarctation repair was found, and as subclavian flap angioplasty carries the possible disadvantage of late contracture of isthmic ductal tissue and possible detrimental effects on the left upper limb, resection and end-to-end anastomosis is recommended.




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