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Ann Thorac Surg 1996;62:778-782
© 1996 The Society of Thoracic Surgeons
Division of Pediatric Cardiology, Children's Hospital, Berne, Switzerland, and Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
Accepted for publication May 2, 1996.
Background. Operative resection is the treatment of choice for native aortic coarctation in most institutions. The ideal timing for elective repair is still a matter of debate. This study evaluated one institution's results with resection and end-to-end anastomosis in the first year of life
Methods. Between January 1987 and December 1993, 46 neonates and infants with functionally isolated aortic coarctation underwent operative resection and end-to-end anastomosis. For the patients included in the study, all hospital records, catheterization data, and operative protocols were evaluated for retrospective analysis. To obtain valid follow-up information, all patients were systematically seen on an outpatient basis during 1994.
Results. After a mean follow-up of 49 ± 24 months (range, 13 to 95 months), recoarctation (arm-leg blood pressure gradient >20 mm Hg) occurred in 5 of 26 patients with neonatal operations (19%) and in 1 of 20 patients with operations in infancy (5%, p= not significant). Four of these 6 children with recoarctation needed reintervention. The other 2 patients had only mild recoarctation (gradients of 22 and 30 mm Hg, respectively) and were not treated. In all 6 patients, recoarctation was diagnosed within the first 6 months postoperatively. During the whole follow-up period, right arm systolic blood pressures slightly above the 90th percentile of normal developed in 11 of the patients (24%) (7 in the group with neonatal operation and 4 after operation in infancy; p = not significant).
Conclusions. Resection with end-to-end anastomosis was shown to be an adequate therapeutic strategy for isolated aortic coarctation in neonates and infants. The results indicate that already beyond the neonatal age, there is a relatively low incidence of recoarctation.
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Ann. Thorac. Surg. 1996 62: 782-783.
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