Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan.
Gen Thorac Cardiovasc Surg. 2021 Dec;69(12):1532-1538. doi: 10.1007/s11748-021-01657-7. Epub 2021 Jun 5.
Although endovascular repair has become an alternative treatment for coarctation of the aorta (CoA) in adults, open repair provides concomitant repair of other cardiac complications, including post-stenotic aneurysm, ascending aortic aneurysm, and intracardiac diseases. We evaluated open anatomical repair for CoA repair in adults.
Eleven patients (6 men, age range 21-63 years) underwent primary CoA repair. Complicating conditions included post-stenotic aortic aneurysm in the descending aorta in 5 patients (45.5%) and ascending aortic aneurysm in 3 (27.3%). Two patients (18.2%) had a bicuspid aortic valve, and one (9.1%) had a quadricuspid aortic valve. Ventricular septal defect was detected in 1 patient (9.1%). Eight patients (72.7%) underwent descending aorta replacement through a left thoracotomy, comprising partial cardiopulmonary bypass in 4 and deep hypothermic circulatory arrest in 4. Of those, the left subclavian artery was reconstructed in 4 patients. The remaining 3 patients (27.3%) underwent total arch replacement, through a median sternotomy in 1 and using a combination of median sternotomy and thoracotomy in 2.
No in-hospital mortality was observed. No spinal cord ischemia or neurological events were encountered, but 1 patient (9.1%) who underwent CoA repair via median sternotomy and thoracotomy required prolonged ventilatory support for more than 48 h. During the follow-up of 90 months (interquartile range 65-124 months), no patient died or required reintervention for the repaired segment.
CoA in adults could be anatomically repaired with graft replacement both through the median sternotomy, the left thoracotomy, and the combination of both approaches, according to the complicated aortic or intracardiac lesions.
尽管血管内修复已成为成人主动脉缩窄（CoA）的一种替代治疗方法，但开放修复可同时治疗其他心脏并发症，包括缩窄后主动脉瘤、升主动脉瘤和心内疾病。我们评估了成人 CoA 修复的开放解剖修复。
11 名患者（6 名男性，年龄 21-63 岁）接受了原发性 CoA 修复。并发疾病包括 5 名患者（45.5%）的降主动脉缩窄后主动脉瘤和 3 名患者（27.3%）的升主动脉瘤。2 名患者（18.2%）存在二叶式主动脉瓣，1 名患者（9.1%）存在四叶式主动脉瓣。1 名患者（9.1%）检测到室间隔缺损。8 名患者（72.7%）通过左开胸术进行降主动脉置换，其中 4 例采用部分心肺转流，4 例采用深低温循环停搏。其中，4 名患者重建了左锁骨下动脉。其余 3 名患者（27.3%）通过正中开胸术进行全主动脉弓置换，1 名患者采用正中开胸术，2 名患者采用正中开胸术和开胸术的组合。
无院内死亡。未发生脊髓缺血或神经事件，但 1 名接受正中开胸术和开胸术联合 CoA 修复的患者需要超过 48 小时的长时间通气支持。在 90 个月（四分位距 65-124 个月）的随访期间，没有患者因修复段死亡或需要再次干预。
根据复杂的主动脉或心内病变，成人 CoA 可通过正中开胸术、左开胸术或两者联合的方法进行解剖修复，并用移植物置换。
