Aortic Coarctation Repairs

The first surgical repair of aortic coarctation was performed in 1944 [1]. Since then three basic surgical methods have evolved for repair of classic short-segment aortic coarctation (CoAo): resection of the coarcted segment with end-to-end anastomosis (Fig. 32.1), subclavian flap aortoplasty (distal left subclavian artery used to augment aortic lumen at the coarctation site), and prosthetic patch aortoplasty (prosthetic patch inserted to widen the aortic lumen) [2]. The choice of procedure depends on the age of the patient, the type of associated malformations, and the morphology of the coarctation itself. Surgical treatment is preferred in neonates and infants. The other procedure types have been used in adults. Subclavian flap aortoplasty is no longer commonly performed because it requires sacrifice of the left subclavian artery which leads to arm claudication with exercise and diminished growth of the left arm [3].