Lerberg D B, Hardesty R L, Siewers R D, Zuberbuhler J R, Bahnson H T
Ann Thorac Surg. 1982 Feb;33(2):159-70. doi: 10.1016/s0003-4975(10)61903-0.
Repair of coarctation of the aorta was performed in 334 patients ranging from less than a year to 16 years of age at Children's Hospital of Pittsburgh from 1953 to 1977. Resection and end-to-end anastomosis were performed in 310, interposition grafts in 7, and other procedures in 17. There were 41 operative deaths among the 95 infants less than 1 year old (43% mortality); all of these infants had associated cardiac anomalies. Only 1 operative death occurred in patients older than a year (0.4% mortality). No hospital deaths occurred in patients with isolated coarctation of the aorta. Eleven late deaths were due to associated anomalies (7) and unrelated or unknown causes (4). Postoperatively, hemorrhage occurred in 7, paradoxical or persistent hypertension in 128, postcoarctectomy syndrome in 32, neurological problems in 14, pulmonary complications in 53, and infections in 12 patients. Restenosis occurred in 26 patients (8%); only 10 have required reoperation. Residual hypertension was present in 28 of 264 patients (11%). Mortality from coarctation resection remains high in infants, but is minimal in children older than 1 year. Based on minimizing the risk of restenosis and residual hypertension, elective repair of coarctation is recommended when the patient is about 6 years of age.
1953年至1977年期间，匹兹堡儿童医院为334例年龄从不到1岁至16岁的患者实施了主动脉缩窄修复手术。其中310例行切除及端端吻合术，7例行间置移植术，17例行其他手术。95例1岁以下婴儿中有41例手术死亡（死亡率43%）；所有这些婴儿均伴有心脏异常。1岁以上患者仅1例手术死亡（死亡率0.4%）。孤立性主动脉缩窄患者无医院死亡病例。11例晚期死亡归因于相关异常（7例）及无关或不明原因（4例）。术后，7例发生出血，128例出现矛盾性或持续性高血压，32例出现缩窄切除术后综合征，14例出现神经问题，53例出现肺部并发症，12例出现感染。26例患者（8%）发生再狭窄；仅10例需要再次手术。264例患者中有28例（11%）存在残余高血压。婴儿期主动脉缩窄切除的死亡率仍然很高，但1岁以上儿童的死亡率极低。基于将再狭窄和残余高血压风险降至最低，建议在患者约6岁时择期修复主动脉缩窄。
