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

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Abstract

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. © 2007 European Association for Cardio-Thoracic Surgery.

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Barreiro, C. J., Ellison, T. A., Williams, J. A., Durr, M. L., Cameron, D. E., & Vricella, L. A. (2007). Subclavian flap aortoplasty: still a safe, reproducible, and effective treatment for infant coarctation. European Journal of Cardio-Thoracic Surgery, 31(4), 649–653. https://doi.org/10.1016/j.ejcts.2006.12.038

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