Early and moderate long-term results of a new surgical technique for repair of aortic coarctation (original) (raw)
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Left subclavian-aortic bypass grafting in primary isolated adult coarctation
Cardiovascular Surgery, 1999
In the adult patient, bypassing the coarcted segment with a tube graft has been described, among others, as a method of repair in re-do cases and in high-risk patients. Since 1992, and owing to its simplicity, it has become our elected approach in all adult cases. Twenty-two patients (mean age 22.8 Ϯ 7.18 years) with isolated aortic coarctation distal to the left subclavian artery were primarily treated with left subclavian-lower descending thoracic aorta bypass using a Hemashield woven double velour graft. There was no hospital mortality nor major postoperative complications. The patients were followed-up for a mean period of 2.36 Ϯ 1.29 years (range 1-5 years). Systolic blood pressure as well as the pressure gradient across the coarcted segment dropped significantly from 181.82 Ϯ 15.7/65.7 Ϯ 13.3 mmHg to 124 Ϯ 13.63/7.41 Ϯ 6.49 mmHg (P ϭ 0.009 and 0.001). Sixteen patients (72.6%) were recorded to be symptom-free and normotensive and seven patients (31.8%) did not show any residual pressure gradient when last seen. The postoperative systolic pressure correlated positively with its preoperative value (P ϭ 0.017) as well as with patient age (P ϭ 0.015). Partial correlation, however, suggested that advanced age upon surgery was the determinant factor responsible for residual postoperative systemic hypertension (P ϭ 0.007). Besides being simple, the procedure is low-risk, permits a significant drop in pressure gradient and improves systolic hypertension through an intermediate follow-up period.
Surgical correction of coarctation of the aorta–A retrospective study
Indian Journal of Thoracic and Cardiovascular Surgery, 2001
Background Different surgical methods, each having its own advantages and disadvantages have been described in the surgical repair of coarctation of the aorta. Methods A comparison of the surgical methods used in our short series of 26 consecutive coarctation repairs have been retrospectively studied. Results Resection and grafting or patch aortoplasty were usually done in older subjects; resection with direct anastomoses and subclavian flap repair were done in the young. Associated intracardiac anomaly repair was also done in the same sitting; being corrected first followed by coarctation repair. Conclusions No major difference was found among the various groups.
Critical review of experience with surgical repair of coarctation of the aorta
The Journal of Thoracic and Cardiovascular Surgery, 1979
Repair of coarctation of the aorta has been performed in 164 patients since July, 1947. Eighteen were younger than 6 months of age, 44 were I to II years, 87 were II to 40 years, and 15 were older than 40 years of age. Resection and end-to-end anastomosis were performed in 92, interposition grafts in 59, and other procedures in 13. Four operative deaths occurred in infants with multiple anomalies (22 percent infant mortality rate). Ten late deaths were due to associated anomalies (three), myocardial infarction (two), cerebrovascular accident (one), rupture of an aneurysm at the graft site (one), and unrelated causes (three). No hospital deaths occurred in patients with isolated coarctation or in patients older than I year, including the 15 patients older than 40 years. Late complications were evaluated in 147 patients followed from 2 months to 28 years. Restenosis occurred in eight (three repaired when younger than 6 months) and false aneurysm at graft sites in two (fatal rupture in one). Residual hypertension occurred in 38 of 147 (25.9 percent) and was related to age at the time of repair: younger than 6 months (three of 13), I to /I years (one of 43), /I to 40 years (29 of 79), and older than 40 years (five of 13). Residual hemodynamic abnormality due to uncorrected associated anomalies, hypertension, ventricular hypertrophy, coronary artery disease, restenosis, or anastomotic aneurysm occurred in 56.1 percent of 98 patients followed at least 2 years. Of this group, 21.4 percent of those repaired before age II years and 70 percent of those repaired after age II had residual hemodynamic abnormality. Hypertension and other residual hemodynamic abnormalities occur frequently after coarctation repair, but significantly less often when repair is performed between the ages of I and II years. The incidence of mild hypertension is increased (f repair is performed after 6 years of age.
BACKGROUND: Coarctation represents 5-8% of congenital heart disease. Residual hypertension remains the main problem after late correction. Surgical treatment in the adult remains a challenge for the surgeon. Our prefered method used in this category is the Subclavian-aortic bypass. MATERIAL AND METHODS: We have reviewed our registry for the period of 12 years (1998-2010) and we found a group of 18 adult patients being operated for coarctation of the aorta. The mean age of this group of patients was 24.7 ± 8.43 years (range 16-42 years). 13 were males and 5 females. RESULTS: Sugical technique: Most of the patients (13 pts, 72%) which were obviously treated with subclavian-aortic bypass with a Dacron prostheses. Mean preoperative and postoperative pressure gradients measured by echocardiography were 77.7 ± 20.16 mmHg and 22.3 ± 9.14 mmHg respectively. No mortality was observed in this series of patients. Chylothorax was the only complication observed in one patient in the early postoperative period. CONCLUSION: Coarctation of the aorta in adults is treated with optimal early results at our surgical centre. Subclavian-aortic bypass grafting requires less aortic dissection, can be performed with a partially occluding clamp, and does not compromise the spinal cord vascularization.
Long-Term Results of Subclavian Flap for Coarct
Background: Coarctation is a congenital narrowing of the aorta that often requires repair during infancy. The subclavian flap aortoplasty was once widely favored for its avoidance of a circumferential suture line and low incidence of recoarctation. The aim of this study is to report the long-term results of the subclavian flap repair for coarctation of the aorta in infants. Methods: Our operative database was queried for infants with coarctation who underwent subclavian flap aortoplasty from 1966 to 1991. Medical records were reviewed for patient characteristics and outcomes. Survivors were identified for additional phone interview. Results: Fifty-five patients met the inclusion criteria. There were 7 early deaths (in hospital), 11 late deaths, 5 patients lost to follow-up, and 32 known long-term survivors with a mean follow-up of 22.0 years (range 2.4-34.9). Hospital mortality was not associated with patient characteristics but was associated with earlier year of surgery (P ¼ .015). A trend toward decreased overall survival was seen in patients with coarctation with associated cardiac defects (P ¼ .072). Reintervention for recoarctation was required in 3 (6.6%) patients and was not related to the patient characteristics. There were no apparent complications related to subclavian artery sacrifice. Conclusions: Subclavian flap aortoplasty provides excellent long-term results for the repair of coarctation in infants. The incidence of recoarctation requiring reintervention is low and compares favorably with other techniques. Compromise of growth or function of the left arm was not appreciated. The subclavian flap technique remains a viable surgical option for the repair of coarctation in infants.
Surgical Treatment of Aortic Coarctation in 29-YEAR Old Patient
We present a case of 29-year-old-woman diagnosed with severe coarctation of the aorta 15mm distal to the left subclavian artery. The patient was admitted in our institution, computed tomohraphy(CT) scan was performed-confirming the diagnosis. After heart team meeting discussion, decision was taken for surgical correction as the best option for the case. Cardiac surgery procedure was performed including: resection of coarctation segment and aortic prosthesis interposition using left heart bypass for optimum spinal cord and visceral organs protection. The patient was discharged on postoperative day 7 on drug therpapy with antiplatelet and dual antihypertensive therapy with β-blocker and calcium channel blocker: Aspirine, Metoprolol and Lercanidipine. At late follow-up examination one year after the surgical correction the patient was normotensive at rest, as well as after treadmill stress test using the standart Bruce protocol. Despite the established good cardiac prophylaxis on newborns, sometimes this disease can remain undiagnosed until adulthood when the complications are starting to present.
Angioplasty for coarctation of the aorta: long-term results
Circulation, 1987
Balloon coarctation angioplasty (BCA) was performed in seven consecutive patients (five boys and two girls) 18 months to 18 years old (mean 9.5) with isolated discrete unoperated coarctation of the aorta. A No. 8F or 9F catheter was chosen with balloon lengths of 30 or 40 mm and maximum inflation diameters 1 mm less than the smallest measured aortic diameter determined 1 cm proximal to the coarctation site. A 10 sec inflation-deflation cycle of 6 to 8 atmospheres (90 to 120 psi) was performed. The peak systolic pressure gradient (PSG) before BCA ranged from 35 to 70 mm Hg (mean 58), and immediately after BCA it decreased to 0 to 20 mm Hg (mean 7). One to two year follow-up (mean 14 months) of the seven patients revealed a PSG range of 10 to 30 mm Hg (mean 19). Repeat angiography was performed immediately proximal to the coarctation site. Three patients (43%) had evidence of aneurysm formation at or immediately distal to the balloon dilatation site. One patient had coarctation resten...