Hu Xiao-peng, Chang Qian, Yu Cun-tao, Qian Xiang-yang, Sun Xiao-gang, Zhang Hai-tao
Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Zhonghua Yi Xue Za Zhi. 2009 Nov 24;89(43):3065-8.
To review the experience of extraanatomic aortic bypass grafting for the treatment of complex aortic coarctation.
From July 1997 to July 2008, 48 consecutive patients (median age 30 years; range 10 to 58 years) with complex aortic coarctation underwent extraanatomic aortic bypass grafting. Indications include: (1) coarctation with intracardiac anomaly (n = 28); (2) coarctation with ascending aortic aneurysm (n = 1); (3) adult coarctation with calcification of local aortic wall (n = 7); (4) coarctation with hypoplasia aortic arch (n = 4); (5) long or multiple coarctation segment (n = 4); (6) coarctation with poststenotic aneurysm (n = 1); and (7) recurrent coarctation (n = 3). Routing of the grafts was:ascending-to-posterior pericardial descending aorta (n = 37); ascending-to-infrarenal abdominal aorta (n = 9); left subclavian artery-to-descending aorta(n = 2). Concomitant cardiac operations were performed in 31 patients (65%) using cardiopulmonary bypass; procedures included: aortic valve replacement in 16; mitral valve repair or replacement in 9; Bentall procedures in 6; patent ductus arteriosus closure in 5; ascending aortic replacement or plasty in 4; ventricular septal defect closure in 3 and coronary artery bypass surgery in 2.
There was no operative death. One patient died of septic shock 39 days postoperatively. Two patients received laparotomy because of mechanical ileus shortly after the ascending-to-subrenal abdominal aortic bypass. Mean systolic blood pressure gradient between upper and lower extremities decreased from (65 +/- 27) mm Hg preoperatively to (14 +/- 11) mm Hg postoperatively (P < 0.05). During a mean follow-up of 28.9 months, there were no late deaths or graft-related complications. Residual mild hypertension were observed in five patients.
Extraanatomic aortic bypass is an attractive treatment option for complex aortic coarctation in adults and adolescents. It can be performed with low morbidity and mortality. The midterm results is favorable.
回顾解剖外主动脉旁路移植术治疗复杂主动脉缩窄的经验。
1997年7月至2008年7月，48例连续的复杂主动脉缩窄患者（中位年龄30岁；范围10至58岁）接受了解剖外主动脉旁路移植术。适应证包括：（1）合并心内畸形的缩窄（n = 28）；（2）合并升主动脉瘤的缩窄（n = 1）；（3）成人缩窄合并局部主动脉壁钙化（n = 7）；（4）合并主动脉弓发育不全的缩窄（n = 4）；（5）长段或多发缩窄节段（n = 4）；（6）合并缩窄后动脉瘤的缩窄（n = 1）；以及（7）复发性缩窄（n = 3）。移植物的路径为：升主动脉至心包后降主动脉（n = 37）；升主动脉至肾下腹主动脉（n = 9）；左锁骨下动脉至降主动脉（n = 2）。31例患者（65%）在体外循环下同期进行了心脏手术；手术包括：16例主动脉瓣置换；9例二尖瓣修复或置换；6例Bentall手术；5例动脉导管未闭闭合；4例升主动脉置换或成形；3例室间隔缺损闭合；2例冠状动脉旁路移植术。
无手术死亡。1例患者术后39天死于感染性休克。2例患者在升主动脉至肾下腹主动脉旁路移植术后不久因机械性肠梗阻接受了剖腹手术。术前上下肢平均收缩压差从（65±27）mmHg降至术后（14±11）mmHg（P < 0.05）。在平均28.9个月的随访期间，无晚期死亡或移植物相关并发症。5例患者观察到残留轻度高血压。
解剖外主动脉旁路移植术是成人和青少年复杂主动脉缩窄的一种有吸引力的治疗选择。它可以在低发病率和死亡率的情况下进行。中期结果良好。
