Influence of age at operation on late results with subclavian flap aortoplasty

Despite the popularity of subclavian flap aortoplasty for repair of aortic coarctation, reported experience and follow-up in neonates is surprisingly limited. This paucity of reports prompted this review of age-related late recurrence rates. Of 83 patients having subclavian flap aortoplasty from 1976 to 1983, 60 were less than 8 weeks of age at operation (mean 2.6 weeks). Operative and late mortality were 18% and 14%, respectively. After a mean follow-up of 26 months, 10 patients have experienced recurrent coarctation (a mean of 10 months elapsed between operations). For 23 patients older than 8 weeks of age at operation (mean 20 months), operative and late mortality were 13% and 10%, mean follow-up is 16 months, and no patient has yet experienced recurrence. Thus, 75% of infants less than 8 weeks of age at operation are free of recoarctation at 2 years, and 100% of older children are free of recoarctation at 2 years (p = 0.06). Review of the literature corroborates our findings. The difference in recurrence rates may be due to age-dependent involution of residual coarctation tissue unavoidably left in place during subclavian flap aortoplasty. We conclude that subclavian flap aortoplasty is effective for correction of coarctation in infants, but patients less than 8 weeks old have a significant risk of early recurrence. Based on this review and our recently reviewed experience with end-to-end anastomosis, our preference is to use the latter in this age group when technically feasible.