The influence of different surgical approaches on arterial rigidity in children after aortic coarctation repair

Abstract

Complications, such as recoarctation or secondary hypertension, probably related to the loss of arterial elasticity, frequently occur after aortic coarctation surgery. This study aimed to investigate arterial compliance as evaluated by automated recording of the QKd interval in patients who underwent repair of coarctation by construction of a subclavian flap compared with those who underwent resection of the narrowed aortic segment with end-to-end anastomosis. Thirty-nine children who underwent surgical repair of aortic coarctation by subclavian flap (n = 19) and by end-to-end anastomosis (n = 20) were enrolled. Arterial stiffness was measured by the noninvasive QKd 100-60 method. Twenty-four-hour ambulatory blood pressure monitoring and a transthoracic echocardiography were also performed. The group of patients who had an end-to-end anastomosis showed better results regarding 24-hour blood pressure profile and QKD 100-60 value compared with those underwent construction of a subclavian flap. Surgical repair of aortic obstruction by end-to-end anastomosis demonstrates better preservation of arterial distensibility than those repaired by subclavian flap. Therefore, it appears to be advantageous, whenever possible, to use the end-end anastomosis approach, which appears to lessen the incidence of the most common complications after aortic arch surgery.