Schoenhoff Florian S, Berdat Pascal A, Pavlovic Mladen, Kadner Alexander, Schwerzmann Markus, Pfammatter Jean-Pierre, Carrel Thierry P
Department of Cardiovascular Surgery, University of Berne, Berne, Switzerland.
Ann Thorac Surg. 2008 Feb;85(2):460-4. doi: 10.1016/j.athoracsur.2007.10.063.
Despite advances in surgical and interventional techniques, the optimal surgical treatment of severe aortic (re) coarctation and hypoplastic aortic arch is still controversial. Anatomic repair may require extensive dissection, cardiopulmonary bypass, and deep hypothermic circulatory arrest with their inherent risks. The aim of this study was to analyze the outcome of off-pump extraanatomic aortic bypass as a surgical alternative to local repair.
From February 2000 to December 2005, ten consecutive patients (median age 20 years; range, 11 to 38 years) with severe aortic (re) coarctation (n = 4) and (or) hypoplastic aortic arch (n = 7) underwent off-pump extraanatomic aortic bypass through median sternotomy. All but three patients had undergone previous surgery for coarctation and angioplasty or stenting. Three patients underwent concomitant replacement of the ascending aorta because of an aneurysm using cardiopulmonary bypass.
Postoperative hospital course was uneventful in all patients. There was no perioperative mortality or significant morbidity. During a mean follow-up of 48 +/- 22 months no patient required additional procedures. All patients were free of symptoms; no patient showed signs of heart failure after follow-up. At last follow-up, no patient presented with claudication, nor any patient experienced orthostatic problems due to a steal phenomenon. During follow-up, hypertension resolved in all patients with residual mild hypertension in two patients.
Off-pump extraanatomic aortic bypass is an attractive treatment option for complex aortic (re) coarctation and hypoplastic aortic arch. Perioperative risks are minimized, hypertension is influenced favorably, and midterm survival is event-free.
尽管手术和介入技术取得了进展，但严重主动脉缩窄（再缩窄）和主动脉弓发育不全的最佳手术治疗仍存在争议。解剖修复可能需要广泛的解剖、体外循环以及深度低温循环停搏，这些都存在固有风险。本研究的目的是分析非体外循环下解剖外主动脉旁路移植术作为局部修复的手术替代方案的疗效。
从2000年2月至2005年12月，连续10例患者（中位年龄20岁；范围11至38岁）患有严重主动脉缩窄（再缩窄）（n = 4）和（或）主动脉弓发育不全（n = 7），通过正中胸骨切开术接受了非体外循环下解剖外主动脉旁路移植术。除3例患者外，所有患者既往均接受过缩窄手术及血管成形术或支架置入术。3例患者因动脉瘤在体外循环下同期进行了升主动脉置换。
所有患者术后住院过程均顺利。无围手术期死亡或严重并发症。在平均48±22个月的随访期间，无患者需要额外手术。所有患者均无症状；随访后无患者出现心力衰竭迹象。在最后一次随访时，无患者出现跛行，也没有患者因盗血现象出现体位性问题。随访期间，所有患者的高血压均得到缓解，2例患者仍有轻度残余高血压。
非体外循环下解剖外主动脉旁路移植术是复杂主动脉缩窄（再缩窄）和主动脉弓发育不全的一种有吸引力的治疗选择。围手术期风险降至最低，对高血压有良好影响，中期生存无事件发生。
