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J Thorac Cardiovasc Surg 2003;126:329-331
© 2003 The American Association for Thoracic Surgery

Editorial

Coarctation: the search for the Holy Grail

^a Division of Pediatric Cardiac Surgery, Children's Memorial Hospital, Chicago, Ill, USA

Received for publication December 31, 2002; accepted for publication March 4, 2003.

^* Address for reprints: Carl Lewis Backer, MD, Children's Memorial Hospital, Division of Pediatric Cardiac Surgery, 2300 Children's Plaza, MC 22, Chicago, IL 60614, USA
cbacker@childrensmemorial.org

The first 300 words of the full text of this article appear below.

One of the Holy Grails of pediatric cardiac surgeons is an operation for coarctation of the aorta that results in no postoperative recoarctation or hypertension. Five decades have gone by since the first coarctation repair by Crafoord in 1944. The results of coarctation repair during that time have been steadily improving. Mortality is now almost exclusively related to associated cardiac anomalies. The greatly feared complications of paraplegia and mesenteric ischemia have been nearly eliminated. Now we are focused on trying to perfect the techniques of coarctation repair to eliminate recoarctation and minimize postoperative hypertension.

Walhout and colleagues¹ have reviewed the outcomes of 262 children undergoing repair of coarctation of the aorta between 1973 and 2000. They compared the results of patients who had a polytetrafluoroethylene (PTFE) patch aortoplasty versus those of patients who had resection of the coarctation with an end-to-end anastomosis (REEA). There was no mortality from isolated coarctation repair. There were no patients with postoperative paraplegia. The techniques (REEA vs PTFE patch aortoplasty) did not differ in the incidence of recoarctation. PTFE patch repair that included coarctation ridge resection was found to be a risk factor for late aneurysm formation. PTFE patch repair was associated with increased late hypertension compared with results in those patients who had REEA. Arch hypoplasia and young age (<1 month) were found to be risk factors for recoarctation. The authors recommend REEA when it is anatomically possible because of the favorable results, especially the lower incidence of late hypertension.

The authors are to be congratulated for their extensive review of one of the largest series of coarctation repairs reported and carefully followed up over a long period of time. Their careful analysis gives a slight edge to REEA over PTFE patch aortoplasty. The main limitations of this review are that it was a . . . [Full Text of this Article]

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