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Right arrow Congenital - acyanotic

Ann Thorac Surg 2002;74:1631-1634
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Intermediate term follow-up of the end-to-side aortic anastomosis for coarctation of the aorta

Adel K. Younoszai, MD*a, Vadiyala Mohan Reddy, MDa, Frank L. Hanley, MDa, Michael M. Brook, MDa

a Divisions of Pediatric Cardiology and Pediatric Cardiothoracic Surgery, University of California San Francisco, San Francisco, California, USA

Accepted for publication June 12, 2002.

* Address reprint requests to Dr Younoszai, The Center for Pediatric and Congenital Heart Diseases, The Cleveland Clinic Foundation/M41, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
e-mail: younosa{at}ccf.org

BACKROUND: Classic techniques for repairing coarctation of the aorta, especially in neonates, have a significant incidence of recurrent obstruction. By connecting the descending aorta to the proximal aortic arch, the end-to-side aortic anastomosis isolates hypoplastic distal arch and encroaching ductal tissue from the anastomotic site.

METHODS: Follow-up data were available for 88 patients (54 male) who underwent an end-to-side aortic anastomosis from November 1992 until November 1999. The median postoperative follow-up was 1.9 years (range, 0.1 to 6.3 years). Fifty-four patients were corrected as neonates. Thirty-four patients were operated on out of the neonatal period (> 1 month of age). A systolic blood pressure gradient >= 20 mm Hg and a Doppler flow velocity >= 2.5 ms across the area of repair were considered a recurrent obstruction.

RESULTS: No patients in the pediatric group had a recurrent obstruction. In the neonatal group, 3 patients (5.5%) had recurrent obstruction. Of those, 2 patients had a reintervention performed; one reintervention was a balloon angioplasty and the other one was a reoperation. Kaplan-Meier analysis of the neonatal group revealed a 95.8% freedom from reintervention at 1 and 2 years.

CONCLUSIONS: The end-to-side aortic anastomosis is an effective repair for coarctation of the aorta. Even when performed in the neonatal period, recurrence of coarctation is rare.




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