One-Stage Repair of Adult Aortic Coarctation and Concomitant Cardiac Diseases: Ascending to Abdominal Aorta Extra-Anatomical Bypass Combined with Cardiac Surgery

• Published in: Heart, lung & circulation lung & circulation, 2019-11, Vol.28 (11), p.1740-1746
• Main Authors: Ge, Yi-Peng, Li, Cheng-Nan, Cheng, Li-Jian, Zheng, Tie, Zheng, Jun, Liu, Yong-Min, Zhu, Jun-Ming, Sun, Li-Zhong
• Format: Article
• Language: English
• Subjects: Adult; Anastomosis, Surgical - methods; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - surgery; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic coarctation; Aortic Coarctation - complications; Aortic Coarctation - diagnosis; Aortic Coarctation - surgery; Ascending to abdominal aorta bypass; Cardiac disease; Computed Tomography Angiography; Echocardiography; Female; Follow-Up Studies; Heart Diseases - complications; Heart Diseases - diagnosis; Heart Diseases - surgery; Humans; Male; Retrospective Studies; Vascular Surgical Procedures - methods
• ISSN: 1443-9506; 1444-2892
• DOI: 10.1016/j.hlc.2018.08.024

To evaluate one-stage repair with ascending to abdominal aorta extra-anatomical bypass combined with cardiac surgery for adult aortic coarctation (COA) concomitant with cardiac diseases. Between February 2009 and September 2016, 24 consecutive patients (79.17% male, mean age 36.04±13.67years) with COA and concomitant cardiac diseases underwent one-stage repair (ascending to abdominal aorta extra-anatomical bypass combined with cardiac surgery). Two (2) patients who underwent off-pump coronary artery surgery combined with ascending to abdominal aorta bypass did not require cardiopulmonary bypass. Twenty-two (22) patients underwent one-stage repair under cardiopulmonary bypass. No in-hospital mortality was observed. There was a significant reduction in baseline systolic blood pressure from 159.80±23.58 to 127.0±6.86mmHg. Mean upper-lower limb blood gradient pressure decreased significantly from 37.80±8.73 to 11.47±2.12mmHg after surgery. Two (2) patients required prolonged mechanical ventilation for respiratory dysfunction. One patient needed temporary continuous renal replacement therapy. No re-exploration for bleeding and gastrointestinal complications was needed. There was no postoperative paraplegia or permanent neurological abnormalities. Grafts were patent for all patients and no graft-related complications were observed in the hospital. Median follow-up was 41.50 months (interquartile range [IQR] 16.75–64.50 months) and 6-year survival was 76.39%. Median number of antihypertensive drugs was 0 (IQR 0–1), which was a significant reduction compared with preoperative drugs (2, IQR 1–3). Ascending to abdominal extra-anatomical aorta bypass combined with cardiac surgery is a safe and effective one-stage repair technique for patients with COA concomitant with cardiac diseases.