Article Text

SPECTRUM OF REOPERATIONS IN PATIENTS WITH PREVIOUS INTERVENTION FOR AORTIC COARCTATION
  1. F A Mitropoulos1,
  2. M A Kanakis1,
  3. H Laks2
  1. 1Department of Paediatric and Congenital Cardiac Surgery, Onassis Cardiac Surgery Centre, Athens, Greece
  2. 2David Geffen School of Medicine at UCLA, Los Angeles, California, USA

Abstract

Objective Recurrent aortic coarctation is related to primary pathology and treatment mode. We review the reoperations in patients with previous coarctation repair at a single center.

Methods Between 1986 and 2002, 201 consecutive patients had surgery for aortic coarctation. Twenty-six patients had been reoperated after previous intervention for aortic coarctation. Median age at initial repair was 52 days. Initial procedures were; end to end anastomosis, 7; percutaneous angioplasty, 5; synthetic patch angioplasty, 5; subclavian flap angioplasty, 3; complex reconstructions, 2 and unknown, 4. Eight of 26 had multiple operations (1 to 4 reoperations).

Results Median age at reoperation was 9.5 years (range, 27 days to 38 years). Median interval time since the most recent intervention was 6 years (range, 7 days to 37 years). Median pressure gradient at reoperation was 50 (range, 15–108 mmHg). Various surgical techniques were performed. Hypothermic circulatory arrest was used in 3, evoked potentials in 8, left heart bypass in 9 and lumbar drain in 2. There was one perioperative mortality and no paraplegia. There were 3 complications, which were open chest, tracheostomy, and bleeding requiring reexploration. At a mean follow-up of 69.8 months 29/31 were alive and none has required reintervention. The systolic blood pressure gradient at the latest follow-up ranged from 0–19 mmHg.

Conclusion Patients after coarctation repair require lifelong follow-up for early detection of complications and recurrence. Surgery remains an effective method for aortic recoarctation repair with low morbidity and mortality.

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