Extended aortic arch anastomosis for repair of coarctation in infancy

Surgical repair of coarctation of the aorta was performed in 17 infants, median age 14 days, median weight 3.5 kg. Extended end-to-end aortic arch anastomosis was used. A long incision was made in the inferior aspect of the aortic isthmus and arch, which was then anastomosed to the obliquely trimmed distal aorta. The aortic arch was hypoplastic in eight patients. Mean cross-clamp time was 17.1 min. Pulmonary artery bands were placed in five patients. Follow-up two-dimensional echocardiographic and Doppler studies on 13 patients 1 to 56 months after surgery demonstrated normal distal aortic flow in 10, slightly decreased flow in two, and diminished flow in one. Patients with abnormal Doppler flow showed no gradient in one case and a 30 mm Hg gradient in two. Extended aortic arch anastomosis is safe in infancy, leaves no native coarctation shelf tissue in the repaired segment, does not sacrifice the subclavian artery, is useful in hypoplastic isthmus, and is at low risk to develop aneurysm or recoarctation.