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J Thorac Cardiovasc Surg 2003;126:521-528
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Comparison of polytetrafluoroethylene patch aortoplasty and end-to-end anastomosis for coarctation of the aorta

^a Children’s Heart Center, Wilhelmina Children’s Hospital UMC, Utrecht, The Netherlands

Received for publication June 18, 2002; revisions received August 20, 2002; revisions received September 16, 2002; accepted for publication October 8, 2002.

^* Address for reprints: Ger B. W. E. Bennink, MD, PhD, Wilhelmina Children’s Hospital, Department of Cardiology/Cardiac Surgery, University of Utrecht, PO Box 18009, 3501 CA Utrecht, The Netherlands
g.bennink{at}azu.nl

OBJECTIVES: Although aneurysm formation and recoarctation after Dacron patch aortoplasty have been reported on extensively, less is known about these outcomes after polytetrafluoroethylene patch repair, which was compared with resection and end-to-end anastomosis in this study.

METHODS: Two hundred sixty-two children had surgical repair of coarctation of the aorta by means of either resection and end-to-end anastomosis (n = 137; mean age, 1.85 ± 3.1 years) or polytetrafluoroethylene patch aortoplasty (n = 118; mean age, 1.09 ± 1.9 years) during a 28-year period. Coarctation was isolated in 109 (41.6%), associated with ventricular septal defect in 77 (29.4%), and associated with complex intracardiac anomalies in 76 (29.0%) patients. Follow-up ranged from 2 days to 29.3 years (median, 11.9 years). Seven patients were lost to follow-up. Kaplan-Meier survival curves were estimated, and multivariable Cox regression analysis was performed for several outcome variables.

RESULTS: Mortality was 8.2% and was associated with intracardiac pathology in all cases. Recoarctation occurred in 53 patients, 23 after resection and anastomosis and 30 after patch repair, not differing statistically (P = .4, log-rank test). Aneurysm formation occurred in 8 patients after patch repair that included ridge resection in 7 of the 8 patients. Late hypertension occurred in less patients (n = 3) after resection and anastomosis than after patch repair (n = 8) (P < .03). Arch hypoplasia (P < .01) and age less than 1 month (P < .001) were found to be independent risk factors for recoarctation.

CONCLUSIONS: Polytetrafluoroethylene patch repair including coarctation ridge resection was found to be a risk factor for aneurysm formation and late hypertension. Arch hypoplasia and young age must be considered to predispose to recoarctation.

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