RESULTS OF THE APPLICATION OF MODIFIED METOD OF RRVERSE SUBCLAVIAN FLAP AORTOPLASTY OF THE LEFT SUBCLAVIAN ARTERY FOR COARCTATION OF AORTA COMBINED WITH HYPOPLASIA OF THE DISTAL AORTIC ARCH

The purpose: This study evaluates long-term results of modified method of reverse subclavian flap aortoplasty, of infants with coarctation of the aorta combined with hypoplasia of the distal aortic arch.

Materials and methods. 64 patients under the age of 1 year, correction of aortic coarctation with hypoplasia of the distal arch department was performed. Patients were divided into 2 groups: the 1st group included patients, whose correction was made by modified method of reverse subclavian flap aortoplasty of the left subclavian artery (n=32); the 2nd one included patients, whose correction was made by the method of extended anastomosis (n=32). Average diameter of aorta at the level of distal aortic arch was 5.1±0.1and 5.5±1.8 (р=0.51), peak gradient at the level of isthmus was 46.6±31.03 and 48.4±32.01(р=0.7). All patients underwent CAT scanning of aorta together with opacification, and Z score of aortic arch was calculated to clarify the level of hypoplasia.

Results. Four-year cumulative survival rate was 95.9% in the 1st group and 95.6% in the 2nd group. In the distant period, isthmus diameter in the 2nd group was significantly different from the one in the 1st group, and was 0.98±0.4 mm and 1.2±0.86 mm correspondingly (р=0.003). For patients from the 1st group, freedom from recoarctation in distant period was 98.2%, while it was 96.3% for patients from the 2nd group, and it was not fairly different from statistical point of view. While comparing the long-term results, statistically significant prevalence of hypertension in the 2nd group (р=0,0034) was observed; pressure gradient in the 1st group at the level of isthmus was 12.2 ±1.06 and in the 2nd group it was 15.5±1.89 (р=0.002); cases of hypertrophy of myocardium of the left ventriculus -10 (40%) in comparison with the 1st group, where they were 2 (8%) (р=0,003).

Conclusions. Modified method of reverse subclavian flap aortoplasty of the subclavian artery exhibits results, which can be compared to those of the method of extended anastomosis.

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