Determinants of early success in repair of aortic coarctation in infants.

Fifty-five infants less than 1 year of age underwent repair of coarctation of the aorta between 1967 and 1981. Sixteen (29%) died while in the hospital, with one death occurring from "pure" coarctation. Of the remaining patients, four among 20 with associated ventricular septal defect (VSD) and 11 among 19 with other major associated cardiac anomalies (p = 0.002) also died. Thirteen (62%) of 21 patients treated by resection and end-to-end anastomosis died in the hospital, while only two (7%) of 30 in whom the subclavian flap repair was used died (p less than 0.0001). Good femoral pulses were present early postoperatively in 29 of 30 patients with the subclavian flap in whom observations were recorded and in nine of 12 patients who received end-to-end anastomosis (p = 0.06). Multivariate analysis showed only the very small size of the patient, the presence of major associated cardiac anomalies other than VSD, and nonuse of the subclavian flap method to be incremental risk factors for hospital death. These data and the reports of others show the subclavian flap technique to be the method of choice for repair of coarctation of the aorta in infants.