Adams Elizabeth E, Davidson William R, Swallow Nicole A, Nickolaus Michelle J, Myers John L, Clark Joseph B
Department of Pediatrics, Penn State Hershey Medical Center, Hershey, PA, USA.
World J Pediatr Congenit Heart Surg. 2013 Jan;4(1):13-8. doi: 10.1177/2150135112466878.
Coarctation is a congenital narrowing of the aorta that often requires repair during infancy. The subclavian flap aortoplasty was once widely favored for its avoidance of a circumferential suture line and low incidence of recoarctation. The aim of this study is to report the long-term results of the subclavian flap repair for coarctation of the aorta in infants.
Our operative database was queried for infants with coarctation who underwent subclavian flap aortoplasty from 1966 to 1991. Medical records were reviewed for patient characteristics and outcomes. Survivors were identified for additional phone interview.
Fifty-five patients met the inclusion criteria. There were 7 early deaths (in hospital), 11 late deaths, 5 patients lost to follow-up, and 32 known long-term survivors with a mean follow-up of 22.0 years (range 2.4-34.9). Hospital mortality was not associated with patient characteristics but was associated with earlier year of surgery (P = .015). A trend toward decreased overall survival was seen in patients with coarctation with associated cardiac defects (P = .072). Reintervention for recoarctation was required in 3 (6.6%) patients and was not related to the patient characteristics. There were no apparent complications related to subclavian artery sacrifice.
Subclavian flap aortoplasty provides excellent long-term results for the repair of coarctation in infants. The incidence of recoarctation requiring reintervention is low and compares favorably with other techniques. Compromise of growth or function of the left arm was not appreciated. The subclavian flap technique remains a viable surgical option for the repair of coarctation in infants.
主动脉缩窄是一种先天性主动脉狭窄，通常需要在婴儿期进行修复。锁骨下动脉瓣主动脉成形术曾因避免了环形缝合线且再缩窄发生率低而广受青睐。本研究的目的是报告婴儿主动脉缩窄锁骨下动脉瓣修复术的长期结果。
查询我们的手术数据库，以获取1966年至1991年间接受锁骨下动脉瓣主动脉成形术的主动脉缩窄婴儿。回顾病历以了解患者特征和结局。确定幸存者进行额外的电话随访。
55例患者符合纳入标准。有7例早期死亡（住院期间），11例晚期死亡，5例失访，32例已知的长期幸存者，平均随访22.0年（范围2.4 - 34.9年）。医院死亡率与患者特征无关，但与手术年份较早有关（P = 0.015）。主动脉缩窄合并心脏缺陷的患者总体生存率有下降趋势（P = 0.072）。3例（6.6%）患者需要再次干预治疗再缩窄，且与患者特征无关。未发现与牺牲锁骨下动脉相关的明显并发症。
锁骨下动脉瓣主动脉成形术为婴儿主动脉缩窄修复提供了出色的长期结果。需要再次干预治疗再缩窄的发生率较低，与其他技术相比具有优势。未发现左臂生长或功能受损。锁骨下动脉瓣技术仍然是婴儿主动脉缩窄修复的可行手术选择。
