Coarctation repair: Modification of end-to-end anastomosis with subclavian flap angioplasty

Background. Subclavian angioplasty and resection and end-to-end anastomosis for coarctation repair carry a substantial risk of recurrence of coarctation. The combined technique using both these methods has shown good results but requires a longer period of continuous cross-clamping of the aorta. Methods. A modified technique using intermittent cross-clamping with a period of reperfusion between cross-clamping periods was used. After the end- to-end anastomosis the clamps are released for 10 minutes and reapplied to do the subclavian angioplasty. Between 1991 and 1996 this was done in 26 infants (mean age, 5 weeks; range, 1 day to 6 months; median, 3 weeks). Mean weight was 3.85 kg (range, 1.5 to 8.4 kg). Mean length of follow-up was 23 months. Twenty-two patients (85%) had associated anomalies, excluding patent ductus arteriosus, and 5 patients (19%) had another procedure performed at the same time. Results. There was no mortality. The mean echocardiographic gradient was 4 mm Hg in the immediate postoperative period and 2.9 mm Hg during follow-up. Residual or recurrent coarctation as detected by significant echocardiography or blood pressure gradient did not develop in any infant. Conclusions. This modified technique of anastomosis is an effective way of relieving coarctation with excellent intermediate-term results.