Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Single Stage Repair for Aortic Coarctation associated with Intracardiac Defects Using Extra-Anatomic Bypass Graft in Adults

  • Received : 2015.10.21
  • Accepted : 2016.01.12
  • Published : 2016.07.30
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Abstract

Background and Objectives: Coarctation of the aorta in adulthood is generally associated with other cardiovascular disorders requiring surgical management. An extra anatomic bypass grafting from the ascending to descending aorta by posterior pericardial approach via median sternotomy could be a reasonable single stage surgical strategy for these patients. Subjects and Methods: Seven male patients aged between 14-41 years underwent an extra anatomic bypass grafting for coarctation repair concomitantly with the surgical management of the associated cardiovascular disorders via median sternotomy. Preoperative mean systolic arterial blood pressure was $161.8{\pm}24.5mmHg$, although the patients were under treatment of different combinations of antihypertensive agents. Additional surgical procedures were: aortic valve replacement (n=4), ventricular septal defect (VSD) closure (n=2), ascending aortic replacement (n=3) and Bentall procedure (n=1). None of our patients have been previously diagnosed or operated on for coarctation. Data were evaluated during their hospital stay and in post-operative follow-up. Results: The post-operative course was uneventful in all but one patient was re-operated on due to bleeding. There was neither mortality nor significant morbidity during the in-hospital period and all patients were discharged within 5-9 (mean: $6.3{\pm}1.5$) days. The mean follow up period was $71.83{\pm}23months$ (range: 23-95 months). Unfortunately one of our patients could not be contacted for a follow up period because of invalid personal data. Conclusion: Coarctation of the aorta in adulthood associated with other cardiovascular disorders can be operated on simultaneously via an extra anatomic bypass grafting technique with low morbidity and mortality.

Keywords

References

  1. Kenny D, Hijazi ZM. Coarctation of the aorta: from fetal life to adulthood. Cardiol J 2011;18:487-95.
  2. Campbell M. Natural history of coarctation of the aorta. Br Heart J 1970;32:633-40. https://doi.org/10.1136/hrt.32.5.633
  3. Mulay AV, Ashraf S, Watterson KG. Two-stage repair of adult coarctation of the aorta with congenital valvular lesions. Ann Thorac Surg 1997;64:1309-11. https://doi.org/10.1016/S0003-4975(97)00814-X
  4. Vijayanagar R, Natarajan P, Eckstein PF, Bognolo DA, Toole JC. Aortic valvular insufficiency and postductal aortic coarctation in the adult. Combined surgical management through median sternotomy: a new surgical approach. J Thorac Cardiovasc Surg 1980;79:266-8.
  5. Powell WR, Adams PR, Cooley DA. Repair of coarctation of aorta with intracardiac repair. Tex Heart Inst J 1983;10:409-13.
  6. Bigdeli AK, Schmitz C, Kaczmarek I, et al. Combined aortic valve replacement and extra-anatomic aorta ascending-descending bypass for recurrent aortic coarctation. Ann Thorac Surg 2010;89:e22-4. https://doi.org/10.1016/j.athoracsur.2009.12.075
  7. Sweeney MS, Walker WE, Duncan JM, Hallman GL, Livesay JJ, Cooley DA. Reoperation for aortic coarctation: techniques, results, and indications for various approaches. Ann Thorac Surg 1985;40:46-9. https://doi.org/10.1016/S0003-4975(10)61168-X
  8. Edie RN, Janani J, Attai LA, Malm JR, Robinson G. Bypass grafts for recurrent or complex coarctations of the aorta. Ann Thorac Surg 1975;20:558-66. https://doi.org/10.1016/S0003-4975(10)64255-5
  9. Kanter KR, Erez E, Willians WH, Tam VK. Extra-anatomic aortic bypass via sternotomy for complex aortic arch stenosis in children. J Thorac Cardiovasc Surg 2000;120:885-90. https://doi.org/10.1067/mtc.2000.110462
  10. Robicsek F. "Very long" aortic grafts. Eur J Cardiothorac Surg 1992;6:536-41. https://doi.org/10.1016/1010-7940(92)90004-H
  11. Izhar U, Schaff HV, Mullany CJ, Daly RC, Orszulak TA. Posterior pericardial approach for ascending aorta-to-descending aorta bypass through a median sternotomy. Ann Thorac Surg 2000;70:31-7. https://doi.org/10.1016/S0003-4975(00)01481-8
  12. Almeida de Oliveira S, Lisboa LA, Dallan LA, Abreu F CA, Rochitte CE, de Souza JM. Extraanatomic aortic bypass for repair of aortic arch coarctation via sternotomy: midterm clinical and magnetic resonance imaging results. Ann Thorac Surg 2003;76:1962-6. https://doi.org/10.1016/S0003-4975(03)01140-8
  13. Wang R, Sun LZ, Hu XP, et al. Treatment of complex coarctation and coarctation with cardiac lesions using extra-anatomic aortic bypass. J Vasc Surg 2010;51:1203-8. https://doi.org/10.1016/j.jvs.2009.12.027
  14. Fedoruk L, Sett SS, Murphy JJ 3rd, LeBlanc JG, Patterson MW. Compression of mediastinal structures treated by extra-anatomic bypass grafting. J Card Surg 2004;19:343-5. https://doi.org/10.1111/j.0886-0440.2004.4093_11.x
  15. Sun LZ, Luo XJ, Liu YM. Single-stage treatment of aortic coarctation and aortic valve disease. Asian Cardiovasc Thorac Ann 2003;11:208-12. https://doi.org/10.1177/021849230301100306
  16. Pethig K, Wahlers T, Tager S, Borst HG. Perioperative complications in combined aortic valve replacement and extraanatomic ascending-descending bypass. Ann Thorac Surg 1996;61:1724-6. https://doi.org/10.1016/0003-4975(96)00140-3
  17. Patel Y, Jilani MI, Cho K. Coarctation of the aorta presenting in a 79-year-old male. Thorac Cardiovasc Surg 1998;46:158-60. https://doi.org/10.1055/s-2007-1010216
  18. Park JH, Chun KJ, Song SG, et al. Severe aortic coarctation in a 75-year-old woman: total simultaneous repair of aortic coarctation and severe aortic stenosis. Korean Circ J 2012;42:62-4. https://doi.org/10.4070/kcj.2012.42.1.62

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