Author + information
- Received April 1, 1986
- Revision received June 3, 1986
- Accepted June 26, 1986
- Published online December 1, 1986.
- Robert H. Beekman, MD, FACC*,1,
- Albert P. Rocchini, MD1,
- Douglas M. Behrendt, MD, FACC1,
- Edward L. Bove, MD, FACC1,
- Macdonald Dick II, MD, FACC1,
- Dennis C. Crowley, MD1,
- A. Rebecca Snider, MD, FACC1 and
- Amnon Rosenthal, MD, FACC1
- ↵*Address for reprints: Robert H. Beekman, MD. Division of Pediatric Cardiology, Room Fl 123, Box 0204, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48109-0204.
To assess the influence of surgical technique on the need for reoperation after coarctation repair in infancy, follow-up data were analyzed for 125 consecutive infants (< 12 months) who underwent repair of coarctation of the aorta by subclavian angioplasty or resection and end to end anastomosis. Sixty-three infants underwent coarctation repair by resection between 1960 and 1980, and 62 underwent subclavian angioplasty between 1977 and 1985. The mean age (±SEM) at operation for infants with subclavian flap angioplasty was 1.54 ± 0.93 months and for infants with resection was 2.70 ± 0.93 months (p = 0.02). There was no difference between the groups in patient weight at initial repair or the proportion of patients with complex anatomy or aortic arch hypoplasia. Follow-up duration for the subclavian flap group was 2.55 ± 0.51 years (range 0.3 to 8.2), and for the resection group was 7.97 ± 3.61 years (range 0.6 to 21).
Indication for reoperation was the presence of a coarctation gradient at rest of 40 mm Hg or greater and arm hypertension. Reoperation was required in 5 patients in the subclavian flap group and 12 patients in the resection group. The mean reoperation rate after subclavian flap repair was 0.0356 reoperations per patient-year, and after resection was 0.0342 reoperations per patient-year (p = 0.94). To determine an individual's risk of requiring reoperation from these group measures, a reoperation risk model was developed. The risk of reoperation by the fifth postoperative year was found to be 16.3% after subclavian flap repair and 15.7% after resection. These risks increase to 30% and 29%, respectively, by the 10th postoperative year.
These data indicate that recoarctation is an important problem after subclavian flap angioplasty in infancy. The risk of requiring reoperation is equivalent during the first 10 postoperative years whether repair is performed by subclavian flap or resection and end to end anastomosis.
- Received April 1, 1986.
- Revision received June 3, 1986.
- Accepted June 26, 1986.
- American College of Cardiology Foundation