European Journal of Cardio-Thoracic Surgery, Vol 10, 884-888, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Early and moderate long-term results of a new surgical technique for repair of aortic coarctation
T Sarioglu, B Kinoglu, A Sarioglu, L Saltik, Y Yalcinbas, T Yildon, R Olga and A Aytac
Department of Cardiovascular Surgery, University of Istanbul, Turkey.
OBJECTIVE: From June 1987 to September 1995, 53 patients underwent a new
technique of coarctation repair. This technique consists of complete
mobilization of the left subclavian artery so that it can be pulled down as
far as possible. METHOD: After all the necessary clamping, the anterior
wall of the aorta is incised longitudinally beginning on the anterior wall
of the left subclavian artery and extending distally to the descending
aorta 1-2 cm past the coarctation. The left subclavian artery is pulled
down so that the proximal end of the incision can reach the distal end.
Then, this longitudinal incision is sutured transversely with 5/0 or 6/0
polydioxanone and continuous technique, enlarging the coarctation site and
also preserving the blood flow to the left upper limb. The ages of the
patients ranged from 16 days to 20 years (mean 3.7 years). Thirty patients
were younger than 1 year old. One patient (1.9%) died postoperatively due
to persistent pulmonary hypertension. RESULTS: There was no pressure
gradient perioperatively through the coarctation site after the repair. The
mean follow-up was 34.4 +/- 27.5 months (range 1-99 months). All patients
but one were in class I effort capacity (NYHA). Doppler echocardiographic
studies were performed in 45 patients postoperatively. There was no
restenosis or aneurysm formation at the coarctation site and the mean
pressure gradients were between 19.8 +/- 16.2 mmHg. CONCLUSION: The authors
experience indicates that this technique could be a good alternative to the
subclavian flap aortoplasty because of the preservation of blood flow to
the left arm.
