Surgery for coarctation of the aorta in the neonate

Between 1972 and 1984, 100 consecutive neonates (less than or equal to 30 days old) underwent repair of coarctation of the aorta. Mean (+/- SD) age at operation was 12.0 +/- 8.0 days; mean weight was 3.1 +/- 0.5 kg. Simple coarctation was present in 29 patients (group I), 32 patients had additional ventricular septal defects (group II) and 39 patients had additional complex heart disease (group III). An associated patent ductus arteriosus was present in a total of 81 patients. Subclavian flap angioplasty (SFA) was performed in 70 patients, resection and end-to-end anastomosis (E-E) in 24 patients, and miscellaneous procedures in six patients. All SFA procedures were performed after 1977, and 87.5% of E-Es were done before 1977. The early mortality was 33.3% for patients undergoing E-E and 11.4% for those undergoing SFA. Freedom from reintervention for recoarctation after 5 years was 92.9% for patients who underwent E-E and 75.2% for those who underwent SFA. Actuarial survival at 4 years was 85.5% for group I, 79.9% for group II, and 42.9% for group III. Follow-up was 97.7% for a mean (+/- SD) of 41.9 +/- 37.1 months. It is likely that some of the differences between patients undergoing SFA and E-E with respect to early mortality and freedom from reintervention are due to the different time frames during which the procedures were done. However, neonatal ductal tissue after SFA may contract and fibrose causing recoarctation, while disadvantages related to the circumferential suture line after E-E may have been overemphasized in the past. A prospective randomized trial of these two techniques is warranted.