Ugur Murat, Alp Ibrahim, Arslan Gokhan, Temizkan Veysel, Ucak Alper, Yilmaz Ahmet Turan
Department of Cardiovascular Surgery, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
Interact Cardiovasc Thorac Surg. 2013 Sep;17(3):467-71. doi: 10.1093/icvts/ivt242. Epub 2013 Jun 5.
Coarctation accompanied by cardiac lesions is a complex clinical situation due to the presence of two different pathologies that necessitate surgical treatment. An individual strategy, according to the severity of the disease, is important to reduce perioperative mortality and morbidity.
We report here on 25 patients with coarctation accompanied by cardiac lesions who were treated by various surgical approaches. Coarctation and associated disease were treated in 14 patients in a single stage by an ascending-to-descending bypass (n = 11) or by a hybrid procedure (n = 3). The remaining 11 patients underwent a two-stage operation for their treatment. Six of these 11 patients who had coronary artery disease or signs of congestive heart failure were first operated for their cardiac disease, whereas in the remaining five patients, who did not have any congestive signs, coarctation repair was performed first.
All the patients were male, between the ages of 20 and 24 years, except for one 45-year-old woman. The mean cross-clamp times, cardiopulmonary bypass times and operation times were 52 ± 14.5, 102.3 ± 28.5 and 174 ± 24.8 min in the extra-anatomical bypass group; 29.8 ± 11.7, 55.5 ± 17.6 and 116 ± 22 min in the two-stage groups and 49 ± 19.8, 63 ± 18.7 and 159 ± 21.3 min in the hybrid patients, respectively. One patient who underwent extra-anatomical bypass died on the 14th postoperative day. There were no events during the follow-up period for the other patients. Also, there were no gradients between the extremities and no graft-related complications.
As a consequence of the progress in the development of endovascular techniques, hybrid treatment is becoming a more popular option for the treatment of coarctation accompanied by cardiac diseases. Two-stage procedures and extra-anatomical bypass might be alternative techniques if endovascular procedures are contraindicated or failing.
伴有心脏病变的主动脉缩窄是一种复杂的临床情况，因为存在两种需要手术治疗的不同病理状况。根据疾病的严重程度制定个体化策略对于降低围手术期死亡率和发病率至关重要。
我们在此报告25例伴有心脏病变的主动脉缩窄患者，他们接受了各种手术方法治疗。14例患者通过升主动脉至降主动脉旁路手术（n = 11）或杂交手术（n = 3）在一期同时治疗主动脉缩窄和相关疾病。其余11例患者接受分期手术治疗。这11例患者中有6例患有冠状动脉疾病或充血性心力衰竭体征，先接受心脏疾病手术，而其余5例无任何充血体征的患者先进行主动脉缩窄修复手术。
除一名45岁女性外，所有患者均为男性，年龄在20至24岁之间。解剖外旁路组的平均阻断时间、体外循环时间和手术时间分别为52 ± 14.5、102.3 ± 28.5和174 ± 24.8分钟；分期手术组分别为29.8 ± 11.7、55.5 ± 17.6和116 ± 22分钟，杂交手术患者分别为49 ± 19.8、63 ± 18.7和159 ± 21.3分钟。一名接受解剖外旁路手术的患者术后第14天死亡。其他患者在随访期间无事件发生。此外，四肢之间无压差，也无移植物相关并发症。
由于血管内技术发展的进步，杂交治疗正成为治疗伴有心脏疾病的主动脉缩窄的更受欢迎的选择。如果血管内手术禁忌或失败，分期手术和解剖外旁路可能是替代技术。
