Subclavian arterioplasty. Repair of coarctation of the aorta in the first year of life.

Between June, 1977, and December, 1982, 106 infants underwent subclavian flap arterioplasty for repair of coarctation of the aorta in the first year of life. This technique was utilized because of our previous experience with the end-to-end technique in 181 infants, in whom there was a recurrence rate of 42% at 5 years. The recurrence rate in 78 of the 81 survivors who have been followed up for a mean of 18.8 months +/- 15.9 months (standard error) is 17.3% at 1 year and 11.1% at 2 and 3 years postoperatively. The presence of associated disease affects mortality: only one death in 34 patients with isolated coarctation; three deaths in 24 with coarctation plus ventricular septal defect; and 21 deaths in 45 infants with coarctation and complex lesions. Our present approach in the group with coarctation plus ventricular septal defect is to repair the coarctation without banding the pulmonary artery and then to close the defect if the infant remains in failure. Operative survival was 13 of 13 without pulmonary artery banding and 11 of 14 with pulmonary artery banding.