Department of Cardiovascular Surgery and Aortic Surgery, Cardiovascular Institute and Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Peking, China.
J Vasc Surg. 2010 May;51(5):1203-8. doi: 10.1016/j.jvs.2009.12.027. Epub 2010 Mar 19.
Coarctation of the aorta with cardiac lesions or complex coarctation is a formidable challenge for cardiac surgeons. Extra-anatomic bypass allows simultaneous intracardiac repair or an alternative approach for patients with complex coarctation.
Between July 1997 and March 2008, 43 patients with coarctation of the aorta underwent extra-anatomic bypass grafting, including 10 ascending-to-descending aorta bypasses and 33 ascending aorta-to-infrarenal abdominal aorta bypasses. Forty patients had additional cardiovascular disorders and concomitant procedures performed including aortic valve replacement, mitral valve replacement, coronary artery bypass grafting, closure of ventricular septal defect and patent ductus arteriosus, ascending aorta repair, and the Bentall procedure. The other three patients had complex coarctation of the aorta, including a long-segment coarctation in two cases, and descending aortic aneurysm in one.
Two patients died perioperatively: one due to air embolism during the cardiopulmonary bypass; one due to septic shock. There were no late deaths. Complications included laparotomy for mechanical ileus in one and re-exploration for bleeding in one case. There were no strokes or paraplegia and no grafted-related complication during follow-up period. Systolic blood pressure dropped from 160 +/- 27 mm Hg before surgery to 114 +/- 16 mm Hg postoperatively. Only two patients with mild hypertension postoperatively needed oral medicine.
Extra-anatomic aortic bypass via median sternotomy or median sternotomy-laparotomy can be performed with low morbidity and mortality. It is a preferable single-stage approach for patients with concomitant complex coarctation and cardiovascular disorders.
伴有心脏病变或复杂型主动脉缩窄的主动脉缩窄对心脏外科医生来说是一个巨大的挑战。体外旁路移植可同时进行心内修复或为复杂型主动脉缩窄患者提供另一种选择。
1997 年 7 月至 2008 年 3 月期间，43 例主动脉缩窄患者接受了体外旁路移植术，包括 10 例升主动脉至降主动脉旁路移植术和 33 例升主动脉至肾下腹主动脉旁路移植术。40 例患者同时还存在其他心血管疾病，并行相应手术，包括主动脉瓣置换术、二尖瓣置换术、冠状动脉旁路移植术、室间隔缺损和动脉导管未闭关闭术、升主动脉修复术和 Bentall 手术。另外 3 例患者患有复杂型主动脉缩窄，其中 2 例为长段缩窄，1 例为降主动脉瘤。
2 例患者围手术期死亡：1 例因体外循环期间空气栓塞；1 例因感染性休克。无晚期死亡病例。术后并发症包括 1 例机械性肠梗阻剖腹术和 1 例出血再次探查术。随访期间无卒中或截瘫，无移植物相关并发症。术后收缩压从术前的 160 ± 27mmHg 降至 114 ± 16mmHg。仅有 2 例患者术后轻度高血压需口服药物治疗。
经正中胸骨切开术或正中胸骨切开术联合剖腹术的体外主动脉旁路移植术可获得较低的发病率和死亡率。对于伴有复杂型主动脉缩窄和心血管疾病的患者，这是一种优选的单阶段方法。
