Long-term follow-up comparing subclavian flap angioplasty to resection with modified oblique end-to-end anastomosis The definitive surgical procedure for correction of aortic coarctation remains controversial. Therefore, we retrospectively reviewed a total of 56 children under 4 years of age with coarctation repair between 1977 and 1986. Thirty-four had the subclavian flap angioplasty technique and 22 had resection with oblique end-to-end anastomosis. The group was further subdivided to include only the 23 infants less than 3 months of age--eight infants with resection with oblique end-to-end anastomosis (less than or equal to 3ETE) and 15 infants with subclavian flap angioplasty (greater than or equal to 3SFA). The remaining 33 patients older than 3 months of age were divided into 14 patients with resection and oblique end-to-end anastomosis (greater than 3ETE) and 19 patients with the subclavian flap angioplasty technique (greater than 3SFA). The overall mortality was not significantly different between techniques. Postoperative hypertension was significantly more prevalent with end-to-end anastomosis than with the subclavian flap angioplasty technique (p less than 0.01). Seven patients had recurrent coarctation. The 6-year actuarial freedom from recoarctation was 93% +/- 6% in the less than or equal to 3SFA group compared with 53% +/- 20% in the less than or equal to 3ETE group (p less than 0.02), but there was no significant difference in those children operated on at a later age regarding the type of coarctation repair. Therefore, we recommend subclavian flap angioplasty in patients less than 3 months of age. In those older than 3 months either procedure is safe and the risk of recoarctation is similar. 