Surgical management for 40 adult patients with aortic coarctation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Changjiang , YANG Jue , LI Xin ,  FAN Ruixin , CHEN Jimei , ZHUANG Jian

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R.China;

Corresponding author：

FAN Ruixin, Email: fanruixin@163.com

Keywords：

Aortic coarctation; extra-anatomic bypass; end-to-end anastomosis; surgical management

DOI：

10.7507/1007-4848.201612042

Video：

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Objective To summarize the experiences of the surgical management for adult patients with aortic coarctation. Methods Clinical data of 40 adult patients diagnosed with aortic coarctation undergoing surgical repair in our center between July 2004 and March 2015 were retrospectively analyzed. There were 28 males and 15 females with a mean age of 26.3±11.0 years (ranging 16-57 years). We evaluated the effect of surgery by the change of pressure gradient between upper limb and lower limb, mechanical ventilation time, and length of ICU stay and hospital stay. Results Forty surgeries were finished successfully. One patient died after surgery. The follow-up ranged from 12 to 36 months. The mean pressure gradient reduced significantly after surgery. There were 6 patients suffering blood hypertension at their discharge, and all of them still need antihypertensive drugs. Conclusion Surgical repair is an effective treatment for adult with aortic coarctation. Extra-anatomic ascending-to-descending aortic bypass and concomitant repair of intracardiac anomalies is safe and effective.

Citation： YU Changjiang, YANG Jue, LI Xin, FAN Ruixin, CHEN Jimei, ZHUANG Jian. Surgical management for 40 adult patients with aortic coarctation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(7): 512-517. doi: 10.7507/1007-4848.201612042 Copy

1.	Cardoso G, Abecasis M, Anjos R, et al. Aortic coarctation repair in the adult. J Card Surg, 2014, 29(4): 512-518.
2.	Ungerleider RM, Pasquali SK, Welke KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg, 2013, 145(1): 150-158.
3.	Gross RE. Surgical correction for coarctation of the aorta. Surgery, 1945, 18: 673-678.
4.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
5.	李渝芬, 李江林, 庄建, 等. 小儿主动脉缩窄诊治及随访 54 例报告. 中国实用儿科杂志, 2005, 20(1): 41-42.
6.	张洪宇, 王为新, 乔衍礼. 外科手术治疗主动脉缩窄 39 例报告. 山东大学学报: 医学版, 2011, 49(9): 160-162.
7.	潘旭东, 郑斯宏, 葛翼鹏, 等. 心外旁路人工血管转流术矫治成人复杂主动脉缩窄. 中华外科杂志, 2012, 50(2): 124-127.
8.	Vijayanagar R, Natarajan P, Eckstein PF, et al. 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(2): 266-268.
9.	Connolly HM, Schaff HV, Izhar U, et al. Posterior pericardial ascending-to-descending aortic bypass: an alternative surgical approach for complex coarctation of the aorta. Circulation, 2001, 104(1): 133-137.
10.	Mckellar SH, Schaff HV, Dearani JA, et al. Intermediate-term results of ascending-descending posterior pericardial bypass of complex aortic coarctation. J Thorac Cardiovasc Surg, 2007, 133(6): 1504-1509.
11.	Wu Q, Chen X, Li H, et al. Ascending-to-descending aortic bypass via posterior pericardium for complex coarctation of aorta. J Card Surg, 2009, 24(2): 167-169.
12.	Yun HC, Lee JY, Yang MK, et al. Extraanatomic ascending-to-descending aortic bypass graft for recurrent, diffuse aortic coarctation. Ann Vasc Surg, 2004, 18(5): 601-603.
13.	胡晓鹏, 于存涛, 钱向阳, 等. 正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形. 中国胸心血管外科临床杂志, 2009, 16(4): 270-273.
14.	Robicsek F, Hess PJ, Vajtai P. Ascending-distal abdominal aorta bypass for treatment of hypoplastic aortic arch and atypical coarctation in the adult. Ann Thorac Surg, 1984, 37(3): 261-263.
15.	Siderys H, Graffis R, Halbrook H, et al. A technique for management of inaccessible coarctation of the aorta. J Thorac Cardiovasc Surg, 1974, 67(4): 568-570.
16.	Levy Praschker BG, Mordant P, Barreda E, et al. Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up. Eur J Cardiothorac Surg, 2008, 34(4): 805-809.
17.	朱秉智, 陈广明, 陈亦江, 等. 成人主动脉缩窄 8 例的诊断和治疗. 南京医科大学学报: 自然科学版, 2000, 20(3): 229-230.
18.	Fernandes SM, Sanders SP, Khairy P, et al. Morphology of bicuspid aortic valve in children and adolescents. Am J Cardiol, 2004, 44(8): 1648-1651.
19.	Teo LLS, Cannell T, Babu-Narayan SV, et al. Prevalence of associated cardiovascular abnormalities in 500 patients with aortic coarctation referred for cardiovascular magnetic resonance imaging to a tertiary center. Pediatr Cardiol, 2011, 32(8): 1120-1127.

1. Cardoso G, Abecasis M, Anjos R, et al. Aortic coarctation repair in the adult. J Card Surg, 2014, 29(4): 512-518.
2. Ungerleider RM, Pasquali SK, Welke KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg, 2013, 145(1): 150-158.
3. Gross RE. Surgical correction for coarctation of the aorta. Surgery, 1945, 18: 673-678.
4. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
5. 李渝芬, 李江林, 庄建, 等. 小儿主动脉缩窄诊治及随访 54 例报告. 中国实用儿科杂志, 2005, 20(1): 41-42.
6. 张洪宇, 王为新, 乔衍礼. 外科手术治疗主动脉缩窄 39 例报告. 山东大学学报: 医学版, 2011, 49(9): 160-162.
7. 潘旭东, 郑斯宏, 葛翼鹏, 等. 心外旁路人工血管转流术矫治成人复杂主动脉缩窄. 中华外科杂志, 2012, 50(2): 124-127.
8. Vijayanagar R, Natarajan P, Eckstein PF, et al. 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(2): 266-268.
9. Connolly HM, Schaff HV, Izhar U, et al. Posterior pericardial ascending-to-descending aortic bypass: an alternative surgical approach for complex coarctation of the aorta. Circulation, 2001, 104(1): 133-137.
10. Mckellar SH, Schaff HV, Dearani JA, et al. Intermediate-term results of ascending-descending posterior pericardial bypass of complex aortic coarctation. J Thorac Cardiovasc Surg, 2007, 133(6): 1504-1509.
11. Wu Q, Chen X, Li H, et al. Ascending-to-descending aortic bypass via posterior pericardium for complex coarctation of aorta. J Card Surg, 2009, 24(2): 167-169.
12. Yun HC, Lee JY, Yang MK, et al. Extraanatomic ascending-to-descending aortic bypass graft for recurrent, diffuse aortic coarctation. Ann Vasc Surg, 2004, 18(5): 601-603.
13. 胡晓鹏, 于存涛, 钱向阳, 等. 正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形. 中国胸心血管外科临床杂志, 2009, 16(4): 270-273.
14. Robicsek F, Hess PJ, Vajtai P. Ascending-distal abdominal aorta bypass for treatment of hypoplastic aortic arch and atypical coarctation in the adult. Ann Thorac Surg, 1984, 37(3): 261-263.
15. Siderys H, Graffis R, Halbrook H, et al. A technique for management of inaccessible coarctation of the aorta. J Thorac Cardiovasc Surg, 1974, 67(4): 568-570.
16. Levy Praschker BG, Mordant P, Barreda E, et al. Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up. Eur J Cardiothorac Surg, 2008, 34(4): 805-809.
17. 朱秉智, 陈广明, 陈亦江, 等. 成人主动脉缩窄 8 例的诊断和治疗. 南京医科大学学报: 自然科学版, 2000, 20(3): 229-230.
18. Fernandes SM, Sanders SP, Khairy P, et al. Morphology of bicuspid aortic valve in children and adolescents. Am J Cardiol, 2004, 44(8): 1648-1651.
19. Teo LLS, Cannell T, Babu-Narayan SV, et al. Prevalence of associated cardiovascular abnormalities in 500 patients with aortic coarctation referred for cardiovascular magnetic resonance imaging to a tertiary center. Pediatr Cardiol, 2011, 32(8): 1120-1127.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical management for 40 adult patients with aortic coarctation

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