Hafen Lee, Shutze William P, Potluri Srinivasa, Squiers John J, DiMaio J Michael, Brinkman William T
Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital, Plano, TX, USA.
Department of Vascular Surgery, Baylor Scott & White The Heart Hospital, Plano, TX, USA.
Ann Cardiothorac Surg. 2022 Jan;11(1):37-45. doi: 10.21037/acs-2021-taes-16.
Aortic coarctation in the adult is usually associated with chronic systemic hypertension, which leads to the sequelae of congestive heart failure, vascular dysfunction and decreased lifespan. Open and endovascular treatment modalities both provide excellent procedural outcomes with minimal mortality and morbidity, but a structured algorithm for workup and periprocedural decision making is not well established. We outline our heart team decision making approach along with our institution's experience treating this condition.
We retrospectively reviewed twenty-four consecutive adult patients treated for aortic coarctation since 2010 at a single center. Outcomes of interest included mortality, treatment approach, device used and post-procedure hypertension status. We describe our protocol for work-up and intervention decision making. We explain our rationale for recommending treatment and the approach, open or endovascular, using existing literature and our experience.
Procedural success rate was 100%, and there were no 30-day, one-year or five-year mortalities, whether the approach was open or endovascular. At last contact, 32% of patients were normotensive and no longer taking blood pressure medications. Several patients presented with complex problems as a result of commonly described complications of prior open or endovascular repair, and we describe our approach to the management of these difficult cases.
Even at a high-volume heart and vascular hospital, aortic coarctation is an uncommon presentation in adult patients. Our experience suggests that excellent outcomes are obtained by discussing each patient among a multidisciplinary heart team and developing a work-up and treatment protocol to guide selection of interventional modality.
成人主动脉缩窄通常与慢性系统性高血压相关，这会导致充血性心力衰竭、血管功能障碍和寿命缩短等后遗症。开放手术和血管内治疗方式均能取得良好的手术效果，死亡率和发病率极低，但用于检查评估和围手术期决策制定的结构化算法尚未完善。我们概述了心脏团队的决策方法以及我们机构治疗这种疾病的经验。
我们回顾性分析了自2010年以来在单一中心接受主动脉缩窄治疗的24例连续成年患者。关注的结果包括死亡率、治疗方法、使用的器械以及术后高血压状态。我们描述了检查评估和干预决策的方案。我们利用现有文献和我们的经验解释推荐治疗方法（开放手术或血管内治疗）的基本原理。
手术成功率为100%，无论采用开放手术还是血管内治疗，均无30天、1年或5年死亡率。在最后一次随访时，32%的患者血压正常，不再服用降压药物。有几位患者因先前开放手术或血管内修复常见的并发症出现了复杂问题，我们描述了处理这些疑难病例的方法。
即使在一家大型心脏和血管医院，主动脉缩窄在成年患者中也是一种不常见的病症。我们的经验表明，通过多学科心脏团队对每位患者进行讨论，并制定检查评估和治疗方案以指导介入方式的选择，可取得良好的治疗效果。
