Subclavian artery flap aortoplasty versus excision with extended end to end anastomosis in surgical management of aortic coarctation in infants / Aboubakr Hasan Mansour ; Supervised Mohammed Abdalraouf Khalil , Mohammed Fawzy Badr Eldin , Tarek Ahmed Nosseir

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Cardiothoracic Surgery

Background: Subclavian flap aortoplasty and excision with extended end to end anastomosis are widely used techniques for surgical repair of coarctation of aorta in infants during first year of life. Aim of the study: Compare and analyze early and mid-term results of aortic coarctation repair using both techniques. Methods: Operative database showed 80 infants; 45 and 35 infants underwent excision with extended end to end anastomosis (group1) and subclavian flap aortoplasty (group2) respectively, from Jan. 2014 to June 2016. Infants with aortic coarctation ± other simple congenital anomalies were included and those with complex cardiac disorders, or who had other cardiac procedure were excluded. Results: Age ranged from 0.8 and 9.6 months including 34 males and 46 females. Weight ranged from 3.4 and 10.5 kg. 18 infants (22.5%) had isolated coarctation and 62 (77.5%) had associated congenital cardiac anomalies. Early postoperatively, no reoperation was required. Early, at 6 and 12 months follow up mean posterior LV, IVS and LVH did not differ significantly and similary, (ICU) stay, mechanical ventilation and organ failure were comparable between both groups. Early, five patients (3 in group1& 2 in group2) had a residual narrowing, while at 6 months follow up for (77/80) infants; 7 (5 in group1& 2 in group2) and at 12 months for (73/80) infants; 7 (4 in group1& 3 in group2) had a systolic blood pressure gradient >20mmHg. Recoarctation dictating intervention happened in 0 cases early, 7 cases (3 in group1& 4 in group2) within 6 months and 9 cases (5 in group1& 4 in group2) within 12 months. No intra-operative nor early postoperative mortalities (in hospital) were recorded, 3 at 6 months (1 in group1& 2 in group2) and 7 deaths (4 in group1& 3 in group2) at 12 months follow up occurred. Conclusion: Infants under 1 year of age shows that both techniques are equally effective having similar rates of recoarctation during mid-term follow-up

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