Comparison of operations for coarctation of the aorta in infants.

During a 12-year-period, 33 infants 4 days to 1 year old underwent 36 operations for treatment of coarctation of the aorta. Associated cardiac anomalies were present in 27 infants (81.8%). All patients presented with congestive heart failure and underwent cardiac catheterization and aortography. Resection was performed in 11 infants, patch aortoplasty in 6, bypass in 2 and subclavian flap angioplasty in 17. Pulmonary artery banding was performed in 4 patients and ligation of a patent ductus arteriosus in 21 patients. Aortic crossclamp time was shorter in the 17 patients who had subclavian flap angioplasty than in 9 patients who had resection (P less than 0.05). Thirty-day mortality was 5 patients (13.9%); all were under 2 months of age at operation and had intracardiac anomalies. Four of them had resection and one had bypass. Mean follow-up was 5 years. Reoperation for recurrent or residual coarctation was performed in 5 patients after resection, 2 after patch aortoplasty and 2 after subclavian flap angioplasty. There was no significant difference in early postoperative arm-to-leg pressure gradients between patients who had resection and patients who had subclavian flap procedure. However, at last follow-up arm-to-leg pressure gradients were lower in 9 infants after subclavian flap (8 +/- 10.1 mmHg) than in 5 infants of similar age who had resection (34 +/- 23.9 mmHg) (P less than 0.05). Subclavian flap angioplasty is safe and more effective than resection for treatment of aortic coarctation in infants.