Levy Praschker Beltran G, Mordant Pierre, Barreda Eleodoro, Gandjbakhch Iradj, Pavie Alain
Thoracic and Cardiovascular Surgery Department, University of Paris VI Pierre et Marie, Groupe Hospitalier Pitie-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
Eur J Cardiothorac Surg. 2008 Oct;34(4):805-9. doi: 10.1016/j.ejcts.2008.06.041. Epub 2008 Jul 26.
The surgical treatment of recurrent coarctation in adults supposes a redo left thoracotomy with adhesions and high risk of bleeding and injury of adjacent nerves. The rate of paraplegia in these cases may reach 2.6%. Extra-anatomic aortic bypass avoids these complications. We present our results with ascending-to-abdominal aorta extra-anatomic bypass for recurrent aortic coarctation in adults.
Between September 1979 and November 2006 12 patients underwent ascending-to-abdominal aorta bypass. There were 10 males and 2 females. Mean age was 36.2+/-11.3 (range 21-57) years old. Mean age at primary repair was 14.3+/-4.2 years old (range 8-21). Operative technique consisted of performing an ascending-to-abdominal aorta bypass via median sternotomy extended into the epigastrium with a supra-umbilical laparotomy through the mid-line abdominal fascia. Concomitant procedures were performed in six patients: three isolated aortic valve replacements (AVR), two ascending aorta graft replacements and one AVR associated with coronary artery bypass graft (CABG).
No postoperative mortality was observed. Mean follow-up time was 10.4+/-9.3 years (range 0.3-27.8). No patients had any graft-related complication or death and all grafts were patent at the end of the follow-up. One patient developed a dilated myocardiopathy, dying at 14 years of follow-up. Four patients had persistence of arterial hypertension controlled with one drug therapy and five patients were asymptomatic.
Ascending-to-abdominal aorta extra-anatomic bypass is a safe, effective and less invasive technique for aortic recoarctation in adults with good results at long-term.
成人复发性主动脉缩窄的外科治疗需要再次进行左开胸手术，存在粘连，出血风险高，且有损伤相邻神经的风险。这些病例中的截瘫发生率可能达到2.6%。解剖外主动脉旁路可避免这些并发症。我们展示了采用升主动脉至腹主动脉解剖外旁路治疗成人复发性主动脉缩窄的结果。
1979年9月至2006年11月期间，12例患者接受了升主动脉至腹主动脉旁路手术。其中男性10例，女性2例。平均年龄为36.2±11.3岁（范围21 - 57岁）。初次修复时的平均年龄为14.3±4.2岁（范围8 - 21岁）。手术技术包括通过正中胸骨切口延伸至上腹部，经中线腹部筋膜进行脐上剖腹术来实施升主动脉至腹主动脉旁路手术。6例患者同时进行了其他手术：3例单纯主动脉瓣置换术（AVR），2例升主动脉移植置换术，1例AVR联合冠状动脉旁路移植术（CABG）。
未观察到术后死亡病例。平均随访时间为10.4±9.3年（范围0.3 - 27.8年）。没有患者出现任何与移植物相关的并发症或死亡，所有移植物在随访结束时均保持通畅。1例患者发生扩张型心肌病，并在随访14年时死亡。4例患者持续存在动脉高血压，通过单一药物治疗得到控制，5例患者无症状。
升主动脉至腹主动脉解剖外旁路是治疗成人主动脉再缩窄安全、有效且侵入性较小的技术，长期效果良好。
