Surgical Treatment of Coarctation of the Aorta

Sung, Si Chan; Bang, Jeung Hee; Pyun, Seung Hwan; Cho, Gwang Jo; Woo, Jong Soo; Lee, Hyoung Doo

Abstract

There remains controversy regarding the appropriate surgical treatment for coarctation of the aorta because of relatively high rate of recoartation and high mortality in the cases associated with complex anomalies. We evaluated 31 consecutive patients who underwent surgical repair of coarctation of the aorta from May 1992 through June 1996. Nineteen patients(61.3%) were neonates and 26(83.9%) were under three months. Nine patients did not have major associated anomalies(Group I), 15 patients had ventricular septal defect(Group II), and 7 patients had major complex anomalies(Group III). 35.5% of the patients had arch hypoplasia. Surgical procedures performed were as follows: extended end-to-end anastomosis in 17 patients, combined resection-flap procedure in 7 patients, and subclavian flap aortoplasty in 7 patients. Residual coarctation occurred in 7(25%) of 28 patients; 2 after subclavian flap aortoplasty(2/6, 33.3%), none after combined resection-flap procedure(0/7, 0%)), and 5 after extended end-to-end anastomosis(5/15, 33.3%). Higher incidence of residual coarctation was noticed in the group with arch hypoplasia. The incidence of postoperative coarctation at a mean follow-up of 20.5 months in survivals was 12.0%(3/25); 2 cases after subclavian flap aortoplasty(2/6, 33.3%), none after combined resection-flap procedure(0/7, 0%), and one after end-to-end anastomosis(1/12, 8.3%). The mortality rate related to coarctation repair was 9.7%(3 patients, all in Group III). This study revealed that isolated coarctation of aorta and coarctation with ventricular septal defect(groups I and II) can be repaired with low mortality, but repair of coarctation with complex anomaly had a high operative mortality. Also the patients with arch hypoplasia had higher incidence of post-operative residual coarctation.