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

Abstract

To evaluate two surgical techniques of treatment for coarctation of the aorta in infants and children, we retrospectively compared our long-term experience with resection and end-to-end anastomosis ("resection") vs Dacron patch aortoplasty in patients operated upon when younger than 16 years of age. Since 1967, 184 patients 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 years, median 4.3 years). There was no statistically significant difference in operative mortality between surgical groups. Among 104 patients with follow-up longer than 1 year, there was no statistically significant difference between the two operations in the appearance of a residual gradient greater than 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 less than 0.025). Late postoperative systolic hypertension was noted in 20 of 104 patients (19%), divided equally between the two operative groups. Most late hypertensive patients (13 of 20, 65%) also had residual coarctation; otherwise, the occurrence of postoperative hypertension was not influenced by the type of repair or age at repair. We conclude that resection and patch aortoplasty are equivalent operations for coarctation of the aorta in infants and children, and that long-term relief of gradient is related to age at operation rather than to technique of repair.