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Eur J Cardiothorac Surg 2007;31:649-653. doi:10.1016/j.ejcts.2006.12.038
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Subclavian flap aortoplasty: still a safe, reproducible, and effective treatment for infant coarctation

Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA

Received 21 August 2006; received in revised form 4 December 2006; accepted 11 December 2006.

^_* Corresponding author. Address: Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Blalock 618, Baltimore, MD 21287, USA. Tel.: +1 410 287 1262; fax: +1 410 955 3809. (Email: lvricella{at}jhmi.edu).

Objective: Subclavian flap repair of infant coarctation has been criticized and in many centers abandoned in favor of resection with end-to-end anastomosis. The goal of this study was to examine intermediate and long-term results of infant subclavian flap aortoplasty, which has been the preferred technique at our institution over the last two decades. Methods: Our patient database identified all infants (age < 1 year) who underwent repair of isthmic coarctation via thoracotomy between January 1984 and December 2004. Procedure details and late results were collected by retrospective review of hospital and clinic data. Follow-up was 95.8% complete at a mean of 6.7 years. Results: Between January 1984 and December 2004, 119 infants underwent isolated subclavian flap repair of coarctation. Mean age and weight at operation were 35 ± 52 days (range 1–269 days) and 3.5 ± 1.3 kg (range 0.7–9.3 kg), respectively. Concomitant pulmonary artery banding was performed in 22% (26/119). In-hospital mortality was 4% (5/119) and cumulative late mortality was 6% (7/114) of patients with long-term follow-up. Actuarial survival at 1, 5, and 10 years was 91, 85, and 85%, respectively. Overall re-intervention rate for re-stenosis was 11% (12/114); 10 patients (9%) underwent balloon angioplasty while 3 patients (3%) required operative revision. All re-stenoses occurred in the descending aorta, and all occurred in patients who had undergone neonatal repair. At late follow-up, there were no significant neurologic events (left recurrent laryngeal nerve injury, stellate ganglion dysfunction, or paraplegia), no clinically significant ischemic arm complications, and no flap aneurysms. Conclusions: Subclavian flap aortoplasty remains our procedure of choice for isthmic coarctation, as it is a simple, technically straightforward technique with a low incidence of re-stenosis and serious early and late morbidity. Furthermore, subclavian flap re-stenoses are easily treated with percutaneous intervention and seldom require surgical re-intervention via thoracotomy.

Key Words: Aortic coarctation • Congenital heart disease • Subclavian artery

This article has been cited by other articles:

				D. E. Troise, M. R. Tagliente, G. Balducci, and P. M. Arciprete Surgical treatment of coarctation in small infants: our experience Eur. J. Cardiothorac. Surg., November 1, 2007; 32(5): 824 - 824. [Full Text] [PDF]

				L. A. Vricella and D. E. Cameron Reply to Troise et al.: Subclavian flap aortoplasty in neonates and infants Eur. J. Cardiothorac. Surg., November 1, 2007; 32(5): 824 - 825. [Full Text] [PDF]