Coarctação da aorta: resultados da cirurgia e análise crítica de diversas técnicas

Seventy patients ranging in age from 14 days to 49 years (mean 7.5 yrs.) were submitted to surgical repair of coarctation of the aorta. Twenty-six (37.1%) were in the first year of life. Surgical techniques performed included patch aortoplasty in 30 cases, subclavian flap angioplasty in 28, resection and end-to-end anastomosis in 9, resection and interposition of a Dacron tube graft in 2 and subclavian aortoplasty with preservation of arterial blood flow to the left arm in 1. There were 6 (8.5%) early and 2 (2.8%) late deaths, not related to the type of repair. Early mortality was clearly related to young age, associated anomalies and severe pre-operative heart failure. All surviving patients present good long-term results and no instance of recoarctation has occurred. No late aneurysm formation was seen in the group of patients submitted to patch aortoplasty probably due to the use of biological patchs in the majority of cases. At present, the authors try to individualize the operation, performing the more suitable technique for each case. Therefore, it is tried to use sublavian flap aortoplasty as much as possible in children below the age of 5 and end-to-end anastomosis or patch aortoplasty in older patients.