Long-term outcome after repair of coarctation in infancy: subclavian angioplasty does not reduce the need for reoperation

To assess the influence of surgical technique on the need for reoperation after coarctation repair in infancy, follow-up data were analyzed for 125 consecutive infants (less than 12 months) who underwent repair of coarctation of the aorta by subclavian angioplasty or resection and end to end anastomosis. Sixty-three infants underwent coarctation repair by resection between 1960 and 1980, and 62 underwent subclavian angioplasty between 1977 and 1985. The mean age (+/- SEM) at operation for infants with subclavian flap angioplasty was 1.54 +/- 0.93 months and for infants with resection was 2.70 +/- 0.93 months (p = 0.02). There was no difference between the groups in patient weight at initial repair or the proportion of patients with complex anatomy or aortic arch hypoplasia. Follow-up duration for the subclavian flap group was 2.55 +/- 0.51 years (range 0.3 to 8.2), and for the resection group was 7.97 +/- 3.61 years (range 0.6 to 21). Indication for reoperation was the presence of a coarctation gradient at rest of 40 mm Hg or greater and arm hypertension. Reoperation was required in 5 patients in the subclavian flap group and 12 patients in the resection group. The mean reoperation rate after subclavian flap repair was 0.0356 reoperations per patient-year, and after resection was 0.0342 reoperations per patient-year (p = 0.94). To determine an individual's risk of requiring reoperation from these group measures, a reoperation risk model was developed. The risk of reoperation by the fifth postoperative year was found to be 16.3% after subclavian flap repair and 15.7% after resection.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				A. C. Fiore, L. K. Fischer, T. Schwartz, S. Jureidini, I. Balfour, D. Carpenter, D. Demello, K. S. Virgo, D. G. Pennington, and R. G. Johnson Comparison of Angioplasty and Surgery for Neonatal Aortic Coarctation Ann. Thorac. Surg., November 1, 2005; 80(5): 1659 - 1665. [Abstract] [Full Text] [PDF]

				G. E. Wright, C. A. Nowak, C. S. Goldberg, R. G. Ohye, E. L. Bove, and A. P. Rocchini Extended Resection and End-to-End Anastomosis for Aortic Coarctation in Infants: Results of a Tailored Surgical Approach Ann. Thorac. Surg., October 1, 2005; 80(4): 1453 - 1459. [Abstract] [Full Text] [PDF]

				A. Kinsara and K.-L. Chan Noninvasive Imaging Modalities in Coarctation of the Aorta Chest, October 1, 2004; 126(4): 1016 - 1018. [Full Text] [PDF]

				M. E. Fawzy, M. Awad, W. Hassan, Y. Al Kadhi, M. Shoukri, and F. Fadley Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults J. Am. Coll. Cardiol., March 17, 2004; 43(6): 1062 - 1067. [Abstract] [Full Text] [PDF]

				D. B. McElhinney, S.-G. Yang, A. N. Hogarty, J. Rychik, M. M. Gleason, C. H. Zachary, J. J. Rome, T. R. Karl, W. M. DeCampli, T. L. Spray, et al. Recurrent arch obstruction after repair of isolated coarctation of the aorta in neonates and young infants: Is low weight a risk factor? J. Thorac. Cardiovasc. Surg., November 1, 2001; 122(5): 883 - 890. [Abstract] [Full Text] [PDF]

				A. Jelly, A. Jelly, M. O. Galal, F. Al Fadley, M. de Moor, and Z. Al Halees Influence of Associated Defects and Type of Surgery in Neonatal Aortic Coarctation Asian Cardiovasc Thorac Ann, June 1, 1999; 7(2): 115 - 120. [Abstract] [Full Text] [PDF]

				H. D. Allen, R. H. Beekman III, A. Garson Jr, Z. M. Hijazi, C. Mullins, M. P. O'Laughlin, and K. A. Taubert Pediatric Therapeutic Cardiac Catheterization : A Statement for Healthcare Professionals From the Council on Cardiovascular Disease in the Young, American Heart Association Circulation, February 17, 1998; 97(6): 609 - 625. [Full Text] [PDF]

				S. F. Kaine, E. O'Brian Smith, A. R. Mott, C. E. Mullins, and T. Geva Quantitative Echocardiographic Analysis of the Aortic Arch Predicts Outcome of Balloon Angioplasty of Native Coarctation of the Aorta Circulation, September 1, 1996; 94(5): 1056 - 1062. [Abstract] [Full Text]

				L. W. E. van Heurn, C. M. Wong, D. J. Spiegelhalter, K. Sorensen, M. R. de Leval, J. Stark, and M. J. Elliott Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990Success of extended end-to-end arch aortoplasty J. Thorac. Cardiovasc. Surg., January 1, 1994; 107(1): 74 - 86. [Abstract] [Full Text]