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Infant coarctation: a spectrum in clinical presentation and treatment

E S Yee, S J Soifer, K Turley

    The Annals of Thoracic Surgery
    |November 1, 1986
    PubMed

    Insights

    Synthetic patch aortoplasty effectively treats coarctation of the aorta in infants, reducing complications and improving blood pressure gradients. This surgical repair offers better outcomes, even for complex cases, with acceptable reoperation rates.

    Area of Science:

    • Pediatric Cardiology
    • Cardiovascular Surgery
    • Congenital Heart Disease

    Background:

    • Coarctation of the aorta is a serious congenital heart defect requiring surgical intervention.
    • Infants with coarctation often present with severe congestive heart failure (CHF), metabolic acidosis, and poor systemic perfusion.
    • Surgical repair aims to relieve the aortic obstruction and improve systemic circulation.

    Purpose of the Study:

    • To evaluate the efficacy and outcomes of synthetic patch aortoplasty compared to end-to-end anastomosis for surgical repair of coarctation of the aorta in infants.
    • To assess perioperative complications, blood pressure gradients, reoperation rates, and late mortality associated with each surgical technique.

    Main Methods:

    • Retrospective analysis of 125 infants (2-365 days old) undergoing surgical repair for coarctation of the aorta between 1975 and 1985.
    • Comparison of outcomes between patients treated with synthetic patch aortoplasty (n=100) and end-to-end anastomosis (n=25).
    • Evaluation of perioperative complications, arm-leg systolic blood pressure gradients, reoperation rates, and late deaths.

    Main Results:

    • No operative deaths occurred in either group.
    • Synthetic patch aortoplasty was associated with minimized perioperative complications (<15%).
    • 82% of patch aortoplasty patients achieved relief of blood pressure gradients compared to 65% with end-to-end anastomosis.
    • Late deaths (16%) were attributed to associated cardiac anomalies, not the repair technique.
    • Reoperation rates were similar (6% for patch, 13% for end-to-end), with some patch reoperations due to hypoplastic arches.

    Conclusions:

    • Synthetic patch aortoplasty is a safe and effective technique for infant coarctation repair, decreasing perioperative complications.
    • This method successfully relieves coarctation gradients and improves early survival, even in complex cases.
    • The technique demonstrates an acceptable rate of recurrent coarctation and has not led to patch aneurysms.

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