Comparison of resection versus patch aortoplasty for repair of coarctation in infants and children.

Abstract

Two surgical techniques for treatment for coarctation of the aorta in infants and children were evaluated. Long-term experience with resection and end-to-end anastomosis (resection) vs. Dacron patch aortoplasty were compared in patients operated upon when younger than 16 yr of age. Patients [184] underwent either resection (n = 96) or patch aortoplasty (n = 88). These groups were comparable in terms of preoperative systolic blood pressure, systolic pressure gradient across the coarctation, the year of operation, age and weight at operation, prevalence of associated cardiovascular defects and duration of postoperative clinical follow-up (1-12.3 yr, median 4.3 yr). There was no statistically significant difference in operative mortality between surgical groups. Among 104 patients with follow-up > 1 yr, there was no statistically significant difference between the 2 operations in the appearance of a residual gradient > 10 mm Hg, but for both groups this degree of residual gradient was more frequent in infants (22 of 43, 51%) than in older children (18 of 61, 31%; P < 0.025). Late postoperative systolic hypertension was noted in 20 of 104 patients (19%), divided equally between the 2 operative groups. Most late hypertensive patients (13 of 20, 65%) had residual coarctation; the occurrence of postoperative hypertension was not influenced by the type of repair or age at repair. Resection and patch aortoplasty apparently are equivalent operations for coarctation of the aorta in infants and children. Long-term relief of gradient apparently is related to age at operation rather than to technique of repair.