Reoperation for Aortic Coarctation: Techniques, Results, and Indications for Various Approaches

Sweeney, Michael S.; Walker, William E.; Duncan, James M.; Hallman, Grady L.; Livesay, James J.; Cooley, Denton A.

doi:10.1016/s0003-4975(10)61168-x

Cited by 85 publications

(45 citation statements)

References 11 publications

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“…Surgical options by direct approach include: resection of the narrowed segment and tube graft replacement, patch graft aortoplasty or subclavian artery patch [2,3,9,10]; all of which require a redo left thoracotomy, dissection of the previous operative site and, eventually in case of difficulty, the instauration of cardiopulmonary bypass and deep hypothermic circulatory arrest with an increasing risk for bleeding, paraplegia, recurrent laryngeal and phrenic nerves injury and pulmonary tissue injury.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up

Praschker

Mordant

Barreda

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: The surgical treatment of recurrent coarctation in adults supposes a redo left thoracotomy with adhesions and high risk of bleeding and injury of adjacent nerves. The rate of paraplegia in these cases may reach 2.6%. Extra-anatomic aortic bypass avoids these complications. We present our results with ascending-to-abdominal aorta extra-anatomic bypass for recurrent aortic coarctation in adults. Methods: Between September 1979 and November 2006 12 patients underwent ascending-to-abdominal aorta bypass. There were 10 males and 2 females. Mean age was 36.2 AE 11.3 (range 21-57) years old. Mean age at primary repair was 14.3 AE 4.2 years old (range 8-21). Operative technique consisted of performing an ascending-to-abdominal aorta bypass via median sternotomy extended into the epigastrium with a supra-umbilical laparotomy through the mid-line abdominal fascia. Concomitant procedures were performed in six patients: three isolated aortic valve replacements (AVR), two ascending aorta graft replacements and one AVR associated with coronary artery bypass graft (CABG). Results: No postoperative mortality was observed. Mean follow-up time was 10.4 AE 9.3 years (range 0.3-27.8). No patients had any graft-related complication or death and all grafts were patent at the end of the follow-up. One patient developed a dilated myocardiopathy, dying at 14 years of follow-up. Four patients had persistence of arterial hypertension controlled with one drug therapy and five patients were asymptomatic. Conclusions: Ascending-toabdominal aorta extra-anatomic bypass is a safe, effective and less invasive technique for aortic recoarctation in adults with good results at longterm. #

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Section: Discussionmentioning

confidence: 99%

Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up

Praschker

Mordant

Barreda

et al. 2008

European Journal of Cardio-Thoracic Surgery

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“…Sweeney et al [23] report the occurrence of bleeding and hemodynamics instability. In our series of cases, there were no problems related to bleeding during the thorax opening and only one patient required reoperation for bleeding, with positive evolution.…”

Section: Discussionmentioning

confidence: 99%

Resultados do tratamento cirúrgico da coarctação de aorta em adultos

Jatene¹,

Abuchaim²,

Oliveira³

et al. 2009

Rev Bras Cir Cardiovasc

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Objective: The aim of this study is to describe our experience in aortic coarctation surgery in adult patients by assessing the immediate and mid-term outcomes.Methods: From January 1997 to March 2000, 50 consecutive adult patients underwent surgery for correction of aortic coarctation, through left lateral thoracotomy. Of these, forty two (84%) patients presented high blood pressure, with mean systolic arterial pressure of 170.56 mmHg (125-220 mmHg). The mean of pressure gradient in the coarctation area was 51.4 mmHg (18-123 mmHg). Other associated surgical cardiovascular diseases were not treated in the same operative act, except in two cases of patent ductus arteriosus (PDA). Three different techniques were used: aortic coarctation resection with end-to-end anastomosis was performed in 20 (40%) patients, coarctation enlargement with bovine pericardial patch was performed in 22 (44%) patients and synthetic tube interposition was performed in eight (16%) patients.Results: Operative morbidity was low; there was one case of bleeding who required reoperation. The most common immediate postoperative event was high blood pressure (98%), but it was easily controlled by intravenous drugs. There was no hospital death. Mean residual pressure gradient was 18.7 (8-33 mmHg). Patients were discharged in 9.5 days (5-30). Postoperative follow-up mean was 46.8 months (1-145 months) in 45 (91.8%) patients. Forty one (91.1%) of these followed-up patients had normal blood pressure, whereas 75.6% of them without drugs intake. 93.3% of these followed-up patients were asymptomatic. Four of them required further surgical operation, one needed a pacemaker implant, other two patients needed a cardiac valve replacement and one had endocarditis. There was one related death due to sepsis secondary to endocarditis.

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“…1 About 5% to 30% of patients with previous coarctation repair experience recoarctation and require reintervention. 1,2 Adult patients with recurrent coarctation and associated intracardiac disease pose a surgical challenge. Several surgical options are available for patients who require reoperation after the initial coarctation repair.…”

Section: Discussionmentioning

confidence: 99%

Aortic valvular insufficiency and postductal aortic coarctation with small aorta syndrome: one-stage surgical management using extra anatomic bypass through median sternotomy

Mizumoto

Tokui

Hiraiwa

et al. 2006

Jpn J Thorac Cardiovasc Surg

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A 30-year-old man who had undergone repair for coarctation of the thoracic aorta at age 7 and mitral valve annuloplasty at age 9 was admitted for shortness of breath and claudication of both lower legs. The pre-operative angiogram showed severe aortic regurgitation, moderate coarctation of the thoracic aorta beyond the left subclavian artery, a degree of hypoplasia of the infrarenal abdominal aorta, and total occlusion of both external iliac arteries. Aortic valve replacement, ascending-to-bilateral femoral arterial bypass, and end expanded polytetra fluoro ethylene (ePTFE) graft-to-descending aorta bypass was performed via a median sternotomy. Ascending-to-descending aortic bypass via the posterior pericardium allows simultaneous intracardiac repair or an alternative approach for the patient with complex coarctation.

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Reoperation for Aortic Coarctation: Techniques, Results, and Indications for Various Approaches

Cited by 85 publications

References 11 publications

Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up

Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up

Resultados do tratamento cirúrgico da coarctação de aorta em adultos

Aortic valvular insufficiency and postductal aortic coarctation with small aorta syndrome: one-stage surgical management using extra anatomic bypass through median sternotomy

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