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The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 128-135, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A Cobanoglu, JF Teply, GL Grunkemeier, CO Sunderland and A Starr
Unexpected and disappointing late results with the subclavian flap
operation prompted this analysis of repair of coarctation in infants under
3 months of age. A total of 134 such patients underwent surgical repair
since 1960 with 55 end-to-end anastomoses performed earlier in our
experience (mean follow-up 5.0 years) and 67 subclavian flap angioplasty
operations performed more recently (mean follow-up 2.0 years). The
operative mortality was not significantly different (p = 0.3) between
end-to-end anastomosis (29%) and subclavian flap angioplasty (19%), but it
was significantly higher (p less than 0.01) in the first week of life
(56%). Recurrent coarctation occurred in 16 cases, necessitating
reoperation. The reoperation-free rates (with standard error) at 5 years
for end-to-end anastomosis and subclavian flap angioplasty were 92% +/- 5%
and 75% +/- 7%, respectively (p = 0.01). Eight of 10 patients who had
reoperation after angioplasty had early recurrence with continued
involution of the periductal tissues and growth of the posterior aortic
ridge. Six patients who had recurrence after anastomosis demonstrated late
anastomotic growth failure. The most common reoperation technique was patch
aortoplasty (10 patients). The high incidence of early recurrence with
subclavian flap angioplasty in infants under 3 months of age suggests
end-to-end anastomosis as the procedure of choice when applicable.
ARTICLES
Coarctation of the aorta in patients younger than three months. A critique of the subclavian flap operation
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