Coarctation of the aorta with arch hypoplasia: improvements on a new technique

The association between coarctation and arch hypoplasia can be difficult to manage surgically. Several complex techniques have been designed for its management (e.g., resection of coarctation with either retrograde subclavian flap or carotid subclavian angioplasty). However, residual gradients are frequent. Recently, a new technique of extensive end-to-end anastomosis was described that has the advantages of leaving the left subclavian artery intact and resulting in a wide anastomosis. The present report details a modification of this technique, which more extensively dissects the arch branches and clamps the aortic arch almost 50% of the way across the innominate branch. The descending aorta is mobilized to the diaphragm. Anastomosis is completed with 7-0 PDS or polypropylene sutures. This type of repair has been performed in 7 patients, with a maximum residual gradient at the end of the procedure of 5 mm Hg. These modifications represent an excellent option to the surgeon in the management of this difficult clinical entity.