| Objective:To investigate the optimal surgical approaches and the optimal operative age for coarctation of aorta, and reduce the complications of early and mid-term and elevate survival rate after repair.Method:Review the information for patients since admission, who underwent one-stage total repair in children's hospital of Fudan university,collect the historical information form and follow-up results. Combine with right statistical method, to measure the correlation factor with survival rate, recoarcation and late follow-up results.Results:From Nov.1999 to Nov.2009,121 patients with coarctation of aorta associated with heart defects underwent one-stage surgical repair in our institution,74 male and 47 female. The age at operation was range 5 days to 12 years (19.54±33.46 months). The weight was range 2.2 to 44 kg (8.01±7.29 kg). Follow-up period was range 3 months to 9 years (31.68±28.08 months). Aortic coarctation was associated with patent ductus arteriosus and isolated in 37 patients; Ventricular septal defect was found in 63 patients, of whitch 29 cases were associated with patent ductus arteriosus. Aortic coarctation was associated with other complex cardiovascular anomalies in 21 cases. All patients underwent one-stage repair. Surgical techniques were as follows: 34 had patch enlargement; 76 had resection with extended end-to-end anastomosis; 11 had subclavian flap aortoplasty. Operation time was range 2 hours to 5 hours (3.11±0.94 hours), cross clamp time was range 14 to 145 minutes (43.791±19.62 minutes).The ventilation time and intensive time was 53.15±63.16 hours and 6.14±6.12 days respectively. None died in operations,5 patients died in early postoperation. One was associated with ventricular septal defects and others were associated with complex cardiovascular anomalies (TGA, Taussig-Bing).116 patients were alive after operation. Early postoperative blood flow velocity of anastomotic site was 1.96±0.57 m/s, detected by Echo; noninvasive blood pressure of right upper limb showed that 22 patients suffered from hypertension and the incidence of hypertension was 18.96%. Middle term follow-up rate was 78.44%,2 patients died in follow-up period. Kaplan-Meier grpups was use to estimate the survival condition, mid-term survival rate is 94.2%.17 patients had an instantaneous peak velocity of more than 2.2 m/s (press gradient 20 mmHg) by Echo acrossing the aortic arch and 5 more than 3 m/s (press gradient 35 mmHg).13 patients suffered from hypertension and the incidence of hypertension was 14.65% at middle term. Multivariate analysis revealed that operative age≤3 months, operative weight≤3 kg, the dysplasia of aortic arch and the early instantaneous peak velocity across the aortic arch were risk factors for recurrent coarctation. Univariate statistical analysis revealed that operative age≥5 years was the independent risk factor for hypertension.16 patients with recurrent coarctation underwent multislice spiral CT angiography (MSCTA) to measure the diameter of plastic aortic arch. Linear analysis was applied to assess the correlation between the diameter and the flow of aortic arch. Correlation for both was significant (p=0.043,r=-0.57).Conclusion:One-stage total repair for aortic coarctation associated with cardiovascular anomalies is feasible. Early surgical mortality is relatively low, and mid-term survival rate is elevated remarkably. But improving late-term outcomes of aortic coarctation remains a surgical challenge.
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