Surgical strategy for treatment of complex aortic coarctation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Xiaohan ^1,2,3 , WU Miti ^2,3 , ZHAN Faliang ^2,3 , YE Tao ^2,3 , GAO Yizhou ¹ , GU Weidong ¹ , GU Qun ¹ ,  SHAO Yongfeng ¹

1. Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P. R. China;
2. The Friendship Hospital of Ili Kazakh Autonomous Prefecture, Ili, 835000, Xinjiang, P. R. China;
3. Ili & Jiangsu Joint Institute of Health, Ili, 835000, Xinjiang, P. R. China;

Corresponding author：

SHAO Yongfeng, Email: shaoyongfeng@njmu.edu.cn

Keywords：

Complex aortic coarctation; extra anatomic bypass; anatomic correction

DOI：

10.7507/1007-4848.202210002

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Objective To summarize the clinical experience of the treatment for complex aortic coarctation with extra anatomic bypass and anatomic correction techniques. Methods The clinical data of patients with complex aortic coarctation treated in the First Affiliated Hospital of Nanjing Medical University and Friendship Hospital of Ili Kazakh Autonomous Prefecture between April 2012 and November 2020 were retrospectively reviewed. Results A total of 12 patients were enrolled, including 5 males and 7 females aged 11-54 (34.3±16.2) years. Extra anatomic bypass grafting was performed in 8 patients and anatomic correction was performed in 4 patients. The operations were successful in all patients. There was no perioperative death. The average cardiopulmonary bypass time was 203.0±46.0 min (7 median incision patients), and the average intraoperative blood loss was 665.0±102.0 mL. The average postoperative ventilator support time was 32.3±7.5 h, and the average postoperative hospital stay time was 10.2±4.3 d. The mean drainage volume of median incision was 1 580.0±360.0 mL, and the mean drainage time was 9.3±2.7 d. The mean drainage volume of left thoracotomy was 890.0±235.0 mL, and the mean drainage time was 4.8±2.5 d. One patient had a transient hoarse after operation and recovered 6 months later. The follow-up period ranged from 2 to 10 years with an average time of 81.0±27.0 months. All patients had a recovery of hypertension, cardiac afterload after 2 years postoperatively. One patient who received an artificial blood vessel replacement in situ was examined stenosis recurrence at the third year after discharge. Others were asymptomatic during the follow-up period. There were no death or other complications. Conclusion The treatment strategy for complex aortic coarctation should be individualized according to the anatomical features and concomitant heart diseases. Extra anatomic bypass technique is a safe and feasible choice.

Citation： XU Xiaohan, WU Miti, ZHAN Faliang, YE Tao, GAO Yizhou, GU Weidong, GU Qun, SHAO Yongfeng. Surgical strategy for treatment of complex aortic coarctation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 776-781. doi: 10.7507/1007-4848.202210002 Copy

1.	Cohen M, Fuster V, Steele PM, et al. Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation, 1989, 80(4): 840-845.
2.	Bouchart F, Dubar A, Tabley A, et al. Coarctation of the aorta in adults: Surgical results and long-term follow-up. Ann Thorac Surg, 2000, 70(5): 1483-1488.
3.	Said SM, Burkhart HM, Dearani JA, et al. Ascending-to-descending aortic bypass: A simple solution to a complex problem. Ann Thorac Surg, 2014, 97(6): 2041-2047.
4.	Wukasch DC, Cooley DA, Sandiford FM, et al. Ascending aorta-abdominal aorta bypass: Indications, technique, and report of 12 patients. Ann Thorac Surg, 1977, 23(5): 442-448.
5.	Hetzer R, Absi D, Miera O, et al. Extraanatomic bypass technique for the treatment of midaortic syndrome in children. Ann Thorac Surg, 2013, 96(1): 183-189.
6.	Delmo Walter EM, Javier MFDM, Hetzer R. Extra-anatomical bypass in complex and recurrent aortic coarctation and hypoplastic arch. Interact Cardiovasc Thorac Surg, 2017, 25(3): 400-406.
7.	Cho S, Lee CH, Kim ER, et al. Outcomes of aortic coarctation surgical repair in adolescents and adults. Interact Cardiovasc Thorac Surg, 2020, 30(6): 925-931.
8.	Meadows J, Minahan M, McElhinney DB, et al. Intermediate outcomes in the prospective, multicenter Coarctation of the Aorta Stent Trial (COAST). Circulation, 2015, 131(19): 1656-1664.
9.	Foster ED. Reoperation for aortic coarctation. Ann Thorac Surg, 1984, 38(1): 81-89.
10.	Sweeney MS, Walker WE, Duncan JM, et al. Reoperation for aortic coarctation: Techniques, results, and indications for various approaches. Ann Thorac Surg, 1985, 40(1): 46-49.
11.	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.
12.	Arakelyan V, Spiridonov A, Bockeria L. Ascending-to-descending aortic bypass via right thoracotomy for complex (re-) coarctation and hypoplastic aortic arch. Eur J Cardiothorac Surg, 2005, 27(5): 815-820.
13.	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: 266-268.
14.	Oliveira SA, Oliveira HA, Kedor HH, et al. Variante te´ cnica para reoperac¸a˜o de coarctac¸a˜o do arcoao´ rtico. Arq Bras Cardiol, 1981, 37: 395-397.
15.	Ge YP, Li CN, Cheng LJ, et al. One-stage repair of adult aortic coarctation and concomitant cardiac diseases: Ascending to abdominal aorta extra-anatomical bypass combined with cardiac surgery. Heart Lung Circ, 2019, 28(11): 1740-1746.
16.	Ma L, Gu Q, Ni B, et al. Simultaneously surgical management of adult complex coarctation of aorta concomitant with intracardiac abnormality. J Thorac Dis, 2018, 10(10): 5842-5849.
17.	Kumar MV, Choudhary SK, Talwar S, et al. Extraanatomic bypass to supraceliac abdominal aorta for complex thoracic aortic obstruction. Ann Thorac Surg, 2016, 101(4): 1552-1557.
18.	Terada T, Yuasa T, Hasegawa M, et al. Ascending to abdominal aorta extraanatomic bypass for descending aortic coarctation: A reconstruction technique without laparotomy or left thoracotomy. Ann Vasc Dis, 2014, 7(3): 354-358.
19.	Yun JK, Kim JB. Extra-anatomic aortic bypass for the management of mid-aortic syndrome caused by Takayasu arteritis. Korean J Thorac Cardiovasc Surg, 2015, 48(1): 70-73.
20.	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.
21.	Tang Y, Han L, Fan X, et al. Extra-anatomical bypass to treat aortic endograft infection after thoracic endovascular aortic repair. Interact Cardiovasc Thorac Surg, 2020, 30(4): 620-622.
22.	Almeida de Oliveira S, Lisboa LA, Dallan LA, et al. Extraanatomic aortic bypass for repair of aortic arch coarctation via sternotomy: Midterm clinical and magnetic resonance imaging results. Ann Thorac Surg, 2003, 76(6): 1962-1966.

1. Cohen M, Fuster V, Steele PM, et al. Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation, 1989, 80(4): 840-845.
2. Bouchart F, Dubar A, Tabley A, et al. Coarctation of the aorta in adults: Surgical results and long-term follow-up. Ann Thorac Surg, 2000, 70(5): 1483-1488.
3. Said SM, Burkhart HM, Dearani JA, et al. Ascending-to-descending aortic bypass: A simple solution to a complex problem. Ann Thorac Surg, 2014, 97(6): 2041-2047.
4. Wukasch DC, Cooley DA, Sandiford FM, et al. Ascending aorta-abdominal aorta bypass: Indications, technique, and report of 12 patients. Ann Thorac Surg, 1977, 23(5): 442-448.
5. Hetzer R, Absi D, Miera O, et al. Extraanatomic bypass technique for the treatment of midaortic syndrome in children. Ann Thorac Surg, 2013, 96(1): 183-189.
6. Delmo Walter EM, Javier MFDM, Hetzer R. Extra-anatomical bypass in complex and recurrent aortic coarctation and hypoplastic arch. Interact Cardiovasc Thorac Surg, 2017, 25(3): 400-406.
7. Cho S, Lee CH, Kim ER, et al. Outcomes of aortic coarctation surgical repair in adolescents and adults. Interact Cardiovasc Thorac Surg, 2020, 30(6): 925-931.
8. Meadows J, Minahan M, McElhinney DB, et al. Intermediate outcomes in the prospective, multicenter Coarctation of the Aorta Stent Trial (COAST). Circulation, 2015, 131(19): 1656-1664.
9. Foster ED. Reoperation for aortic coarctation. Ann Thorac Surg, 1984, 38(1): 81-89.
10. Sweeney MS, Walker WE, Duncan JM, et al. Reoperation for aortic coarctation: Techniques, results, and indications for various approaches. Ann Thorac Surg, 1985, 40(1): 46-49.
11. 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.
12. Arakelyan V, Spiridonov A, Bockeria L. Ascending-to-descending aortic bypass via right thoracotomy for complex (re-) coarctation and hypoplastic aortic arch. Eur J Cardiothorac Surg, 2005, 27(5): 815-820.
13. 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: 266-268.
14. Oliveira SA, Oliveira HA, Kedor HH, et al. Variante te´ cnica para reoperac¸a˜o de coarctac¸a˜o do arcoao´ rtico. Arq Bras Cardiol, 1981, 37: 395-397.
15. Ge YP, Li CN, Cheng LJ, et al. One-stage repair of adult aortic coarctation and concomitant cardiac diseases: Ascending to abdominal aorta extra-anatomical bypass combined with cardiac surgery. Heart Lung Circ, 2019, 28(11): 1740-1746.
16. Ma L, Gu Q, Ni B, et al. Simultaneously surgical management of adult complex coarctation of aorta concomitant with intracardiac abnormality. J Thorac Dis, 2018, 10(10): 5842-5849.
17. Kumar MV, Choudhary SK, Talwar S, et al. Extraanatomic bypass to supraceliac abdominal aorta for complex thoracic aortic obstruction. Ann Thorac Surg, 2016, 101(4): 1552-1557.
18. Terada T, Yuasa T, Hasegawa M, et al. Ascending to abdominal aorta extraanatomic bypass for descending aortic coarctation: A reconstruction technique without laparotomy or left thoracotomy. Ann Vasc Dis, 2014, 7(3): 354-358.
19. Yun JK, Kim JB. Extra-anatomic aortic bypass for the management of mid-aortic syndrome caused by Takayasu arteritis. Korean J Thorac Cardiovasc Surg, 2015, 48(1): 70-73.
20. 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.
21. Tang Y, Han L, Fan X, et al. Extra-anatomical bypass to treat aortic endograft infection after thoracic endovascular aortic repair. Interact Cardiovasc Thorac Surg, 2020, 30(4): 620-622.
22. Almeida de Oliveira S, Lisboa LA, Dallan LA, et al. Extraanatomic aortic bypass for repair of aortic arch coarctation via sternotomy: Midterm clinical and magnetic resonance imaging results. Ann Thorac Surg, 2003, 76(6): 1962-1966.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical strategy for treatment of complex aortic coarctation

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