Yousif Afram, Kloppenburg Geoffrey, Morshuis Wim J, Heijmen Robin
Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands.
Interact Cardiovasc Thorac Surg. 2016 Oct;23(4):526-30. doi: 10.1093/icvts/ivw206. Epub 2016 Jun 26.
Aortic coarctation presenting during adult life most frequently represents cases of re-coarctation, following previous transcatheter or surgical therapy, or missed cases of native coarctation. In the area of evolving endovascular therapy, we believe that there is still a place for durable open repair by means of resection and interposition grafting. We, therefore, evaluated our results in adult patients with primary aortic coarctation or complications of a previous coarctation repair.
A total of 38 patients were operated between 1989 and 2014. Median age was 43 years (range 18-69 years), and 20 were male (52.6%). Seventeen patients (44.7%) had recurrent coarctation or dilatation after previous repair during childhood; the remaining 21 (55.3%) had primary coarctation diagnosed at adult age. Data were retrospectively reviewed and analysed for indications, type of repair, operative details and outcomes.
Resection and interposition grafting was performed primarily with the use of left-left bypass (mean cross-clamping time 41 ± 13 min). There were no in-hospital deaths, stroke, spinal cord ischaemia, renal or respiratory failure. No patient had evidence of symptomatic aortic re-coarctation or pseudoaneurysm formation on follow-up. Long-term survival after 20 years was 94.7%.
Open surgical repair of primary, recurrent or complicated adult aortic coarctation by interposition grafting is a safe and feasible therapeutic option, providing durable long-term results and excellent long-term survival.
成年期出现的主动脉缩窄多数情况下是既往经导管或外科治疗后再缩窄的病例，或是先天性缩窄漏诊的病例。在不断发展的血管内治疗领域，我们认为通过切除和植入移植物进行持久的开放修复仍有一席之地。因此，我们评估了成年原发性主动脉缩窄或既往缩窄修复并发症患者的治疗结果。
1989年至2014年间共对38例患者进行了手术。中位年龄为43岁（范围18 - 69岁），男性20例（52.6%）。17例患者（44.7%）在儿童期既往修复后出现复发性缩窄或扩张；其余21例（55.3%）在成年期诊断为原发性缩窄。对数据进行回顾性审查和分析，内容包括手术指征、修复类型、手术细节和结果。
主要采用左 - 左旁路进行切除和植入移植物手术（平均阻断时间41±13分钟）。无住院死亡、中风、脊髓缺血、肾或呼吸衰竭发生。随访期间，无患者出现有症状的主动脉再缩窄或假性动脉瘤形成的证据。20年后的长期生存率为94.7%。
通过植入移植物对成年原发性、复发性或复杂性主动脉缩窄进行开放手术修复是一种安全可行的治疗选择，可提供持久的长期效果和出色的长期生存率。
