High incidence of aneurysm formation following patch plasty repair of coarctation

Abstract

Repair of aortic coarctation was performed in 152 adolescent and adult patients (mean age 28.5 years, range 14-67 years). Ninety patients were treated with patch plasty, 33 with end-to-end anastomosis, 18 with interposition of a tubular graft, 6 with prosthetic bypass and 5 with direct plasty. There were two (1.3%) early and ten (6.6%) late deaths after 2.9 to 11.8 (mean 6.6) years. Of the remaining 140 patients, 129 (92.1%) were reexamined with computed tomography and angiography after 1.5 to 17.2 (mean 9.1) years postoperatively. In 27 patients (35.1%) of the patch plasty group significant dilatation at the operative site was observed and reoperation for aneurysm formation was required in 15 patients (19.5%). Resection of the intimal crest did not increase the probability of aneurysm formation, whereas Dacron as patch material and late hypertension had a significant influence. Six of the ten late deaths occurred in the patch plasty group. Rupture of an aneurysm at the operative site was proved in two of these patients, and three patients died suddenly for unknown reasons. In the other groups significant dilatation was observed in 13 patients and 3 local aneurysms required reoperation (2 after end-to-end anastomosis and 1 after direct plasty). We conclude that patch plasty repair of coarctation should be abandoned in adults. End-to-end anastomosis is advisable only if possible without excessive tension. Reoperation with interposition of a tubular graft on left heart bypass proved to be a safe method.

Percutaneous Endovascular Repair of Aneurysm After Previous Coarctation Surgery

“…Our encouraging results in 6 consecutive patients undergoing endovascular repair for post-patch-graft aortoplasty aneurysm suggest potential for a new nonsurgical option. 3,11,16 The problem of postsurgical aneurysm formation has also been recognized after bypass grafting for long aortic coarctation and even after subclavian flap aortoplasty. 12,16 Reoperation after previous patch-graft aortoplasty carries a 14% mortality rate and significant morbidity, including paralysis of the nervus recurrens and bleeding complications 3,17 ; similarly, Kieffer et al 18 found that open surgery for thoracic aneurysm in association with aberrant subclavian arteries is associated with a 23.5% mortality rate and a 13% paraplegia rate.…”

Enhanced Vascular Biocompatibility and Remodeling of Decellularized and Secured Xenogeneic/Allogeneic Matrices in a Porcine Model

“…However, prosthesis recellularization, which is of major concern regarding vessel regeneration for growth, viability potential, and mechanical stability, was different between tissues [12]. For this aspect, DPPt and DHP showed the best results, while DHFL and GBP showed similar results as synthetic grafts without viability and growth potential, prone to calcifications, aneurysm formation, and unable to fight against infection [19, 20]. …”

Complications following reparative surgery for aortic coarctation or interrupted aortic arch

“…Although improved rates of early mortality after aortic arch repair have been reported, 1-4 a variety of long-term complications persist, the most common of which include persistent or relapse of hypertension, coronary artery disease, aortic aneurysm formation, aortic dissection, and infective endocarditis. 5,[9][10][11] Hypertension in particular continues to carry long-term morbidity following the repair. The vast majority of these complications can be attributed to recurrent or residual stenosis at the anastomotic site, regardless of the repair technique.…”