Primary repair of coarctation of the thoracic aorta by patch graft aortoplasty. A three-decade experience and follow-up in 60 patients.

OBJECTIVES

The present report is a critical review on primary repair of aortic coarctation by patch aortoplasty on the basis of over 30 years surgical experience.

METHODS

Since 1962, 60 patients (mean age 9.4 +/- 4.8 years, range 2-25 years), affected by aortic coarctation, underwent patch aortoplasty repair. During the operation protective guidelines were adopted: additional external Dacron was placed around the repaired site in cases of friable host tissue, the aortic ridge was not excised to leave the posterior aortic wall intact, and the patent ductus arteriosus or ligamentum arteriosum was transected and sutured. Prophylactic measures of neurologic sequelae were: dual pressure monitoring, sequential aortic clamping, surgical shunt or left heart bypass associated with moderate hypothermia when the distal aortic pressure was less than 50 mmHg.

RESULTS

No early deaths occurred. The overall survival rate was 92.77 +/- 4.04% at 31 years from surgery. Three late deaths occurred. Pressure gradients across the patch ranged between 9 and 20 mmHg. Late aneurysm occurred in one patient (1.3%), 2 years after bacterial endocarditis had developed on a biscuspid aortic valve.

CONCLUSIONS

Patch aortoplasty is an effective and safe surgical procedure for primary repair of isthmic aortic coarctation when other surgical techniques cannot be performed.