Surgical Correction of Coarctation of the Aorta by an "Isthmusplastic" Operation

Vossschulte, K

doi:10.1136/thx.16.4.338

Cited by 115 publications

(41 citation statements)

References 8 publications

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“…Although the use of a more distensible PTFE patch instead of a Dacron ® graft was initially promising, it has been shown that there is a risk of aortic aneurysms and recoarctation at a rate of 7% and 25%, respectively. Furthermore, some authors have suggested that the posterior wall membrane resection plays an important role in the development of aneurysms in patients undergoing patch graft aortoplasty and, therefore, the posterior membrane should not be resected [4,5]. In our study, patch graft aortoplasty was performed in seven adult patients.…”

Section: Discussionmentioning

confidence: 94%

Surgical Management of Aortic Coarctation from Infant to Adult

et al. 2018

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Objective: In the present study, we aimed to retrospectively investigate the early and late results of different surgical treatment techniques applied in different age groups with coarctation of the aorta (CoA). Materials and Methods:Between January 2007 and February 2017, 26 patients (12 males, 14 females; mean age: 12.2±12.4 years; range: 29 days-34 years) who underwent surgery with the diagnosis of CoA were evaluated. Overall, 11 of these patients (42.3%) were in the infantile period, whereas 15 patients (57.7%) aged between 6 and 34 years. Resection and end-to-end anastomosis were performed in 13 patients (50%). Bypass grafting was performed in six patients (23.1%), and patch plasty was performed in seven patients (26.9%).Results: A patient (3.8%) who was operated on during the infantile period died early, whereas another patient (3.8%) died 2 years after the surgery. Recoarctation was detected in two patients. A patient underwent balloon dilatation, whereas another patient underwent balloon dilatation and stenting. In patients who underwent resection and end-to-end anastomosis based on postoperative echocardiography results during follow-up, a lower statistically significant gradient was observed compared with the preoperative period. Despite the decrease in the left ventricular systolic diameter (LVSD) and the increase in the ejection fraction (EF) the decrease in LVSD and increase in EF were not statistically significant. In patients who underwent patch plasty or graft interposition, the low values of the gradient and left ventricular diastolic diameter in the postoperative follow-up were statistically significant. However, the decrease in LVSD and increase in EF were not statistically significant. Conclusions:Our clinical experience suggests that repairing with resection and end-to-end anastomosis is a more appropriate treatment option during the infancy, whereas patch plasty or bypass grafting may be preferred in advanced ages.

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Section: Discussionmentioning

confidence: 94%

Surgical Management of Aortic Coarctation from Infant to Adult

et al. 2018

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“…In this approach, the ductal tissue is ligated and divided, a longitudinal incision across the coarctation is made, and a prosthetic patch is sutured in place to enlarge the stenotic region ( Figure 3B). This technique can be applied to longer segments of coarctation, avoids a circumferential suture line, and minimizes aortic mobilization and ligation of intercostal arteries [33] . While recoarctation rates of 5%12% [34] were lower compared to the resection and endtoend anastomosis technique, aortic aneurysm was a longterm concern, with rates between 18%51% of patients [3538] .…”

Section: Surgical Repairmentioning

confidence: 99%

Coarctation of the aorta: Management from infancy to adulthood

Török

Campbell

Fleming

et al. 2015

WJC

235

151

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Coarctation of the aorta is a relatively common form of congenital heart disease, with an estimated incidence of approximately 3 cases per 10000 births. Coarctation is a heterogeneous lesion which may present across all age ranges, with varying clinical symptoms, in isolation, or in association with other cardiac defects. The first surgical repair of aortic coarctation was described in 1944, and since that time, several other surgical techniques have been developed and modified. Additionally, transcatheter balloon angioplasty and endovascular stent placement offer less invasive approaches for the treatment of coarctation of the aorta for some patients. While overall morbidity and mortality rates are low for patients undergoing intervention for coarctation, both surgical and transcatheter interventions are not free from adverse outcomes. Therefore, patients must be followed closely over their lifetime for complications such as recoarctation, aortic aneurysm, persistent hypertension, and changes in any associated cardiac defects. Considerable effort has been expended investigating the utility and outcomes of various treatment approaches for aortic coarctation, which are heavily influenced by a patient's anatomy, size, age, and clinical course. Here we review indications for intervention, describe and compare surgical and transcatheter techniques for management of coarctation, and explore the associated outcomes in both children and adults.

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“…On the other hand, it is a consensus that symptomatic patients should undergo surgery promptly. Although all techniques already described have applications, the 3 following methods have emerged as excellent for routine repair of coarctation of the aorta: 1) aortoplasty with a subclavian flap 1 preserving or not blood flow to the ipsilateral (left) upper limb; 2) end-to-end anastomosis with resection of the coarctation of the aorta 2,3 ; and 3) extended aortoplasty with widening of the stenotic area with synthetic tissue 4 . All methods have applications and limitations.…”

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confidence: 99%