Coarctation of the Aorta with Aortic Arch Hypoplasia: Tackle from the Front or the Side?

In their single ‐ institution retrospective review, Egunov et al. describe the short ‐ term outcomes of the pediatric patients who underwent reoperative surgery for residual or recurrent coarctation after a previous coarctation repair. 1 There were 51 patients over 12 years. The indication for the operation was the recurrence of coarctation with a significant gradient as measured by the arm to leg blood pressure difference or by echocardiography and presence of associated transverse arch hypoplasia ( Z score ≤ − 2). Thus, these patients were unsuitable for a percutaneous approach or reoperative surgery via a left thoracotomy. 2 Hence, the approach was via a median sternotomy using moderate hypothermia and antegrade cerebral perfusion. 14% of the patients underwent reoperative median sternotomy, and all these had their first surgery as a neonate. Prosthetic patch aortoplasty (45%) was the most common rerepair technique used, followed by resection with an extended end ‐ to ‐ end anastomosis (29%) and an interposition graft implantation (25%). Their outcomes were excellent, with no operative mortality and no residual coarctation. The only morbidity recorded was the occurrence of chylothorax. At a median follow ‐ up of 2 years, there were no recurrences or any mortality. Also, there was a resolution of systemic hypertension in most patients. For first was