Comparison of different surgical techniques for repair of aortic coarctation in childhood

Background: This retrospective study aims to present the mid-term results and complications of different surgical techniques performed in our clinic due to aortic coarctation. Methods: One hundred and six patients (61 males, 45 females; mean age 2.0 +/- 3.7 years; range 2 days to 16 years) who underwent repair of aortic coarctation between January 2005 and December 2013 were included in the study. Patients were divided into four according to age groups: newborns (n=36, 34%), infants (n=42, 39.6%), 1-5 years (n=13, 12.2%), and >5 years (n=15, 14.2%). Patients were performed 122 surgical procedures. Patients were operated following moderate hypothermia (34-35 degrees C) through left posterolateral thoracotomy with incision performed at fourth intercostal space. Results: Mean follow-up duration was 34 +/- 11 months (range 1 to 64 months). Of the patients, end-to-end anastomosis was performed in 45.9%, extended end-to-end anastomosis in 26.2%, patch plasty in 22.1%, and graft interposition in 5.7%. During follow-up, recoarctation developed in 16 (15.1%) patients. All patients who developed recoarctation were younger than six months. Recoarctation was statistically significant in newborn age group (27.8% vs. 8.5%, p<0.05). Recoarctations which developed in newborn period were performed surgery and those that developed in later period were first performed balloon angioplasty and afterwards surgery. Twenty patients (18.8%) died in early postoperative period. Conclusion: A comparison of the surgical techniques according to age groups revealed that extended end-to-end anastomosis was preferred at higher rates in newborn period, while end-to-end anastomosis was preferred at higher rates in other age groups. Recoarctation and mortality rates were higher in patients who were performed surgery during newborn period.