Qiao Huanyu, Yang Bo, Rotzinger David C, Liu Yongmin
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
J Thorac Dis. 2024 Jul 30;16(7):4633-4644. doi: 10.21037/jtd-24-985. Epub 2024 Jul 26.
Aortic coarctation (COA) in adults combined with poststenotic aneurysm (PA) or poststenotic dissection (PD) is rare and challenging to manage. The existence of multiple factors such as kinking, comorbidities, previous surgical history, and descending aortic lesions increases the difficulty of treatment, and there are currently few clinical reports. The purpose of this study was to present our surgical experience in dealing with such patients.
A retrospective study was conducted on 20 consecutive patients with COA combined with PA or PD who were treated in our center from December 2015 to April 2019. The basic principles, methods, and short- and mid-term prognosis of surgery are present carefully. This paper introduces the individualized treatment scheme as well as its advantages and disadvantages in detail.
The condition of the included patients was complicated, including 12 cases of PA and 8 of PD. Although different surgical schemes were adopted, procedural success rate was 100%. There were no other surgical complications except 2 cases of anastomotic bleeding and 1 case of spinal cord injury. The results of computed tomography angiography (CTA) demonstrated that 9 cases achieved anatomical correction, 10 cases of PA or PD were eliminated or thrombosed to varying degrees, and only 1 case of PA had no obvious change. Up to the follow-up period, except for 1 patient who had a slight cerebrovascular accident and 1 who had no change in PA underwent cheatham platinum (CP) stent surgery, no other cardiovascular adverse events occurred and all patients recovered well.
The optimal surgical strategy developed collaboratively by cardiac surgeons and endovascular specialists has achieved satisfactory short- and mid-term results for COA patients combined with PA or PD. Further research is still necessary, due to the limited number of cases.
成人主动脉缩窄（COA）合并缩窄后动脉瘤（PA）或缩窄后夹层（PD）较为罕见，治疗具有挑战性。诸如血管扭曲、合并症、既往手术史以及降主动脉病变等多种因素增加了治疗难度，目前临床报道较少。本研究旨在介绍我们处理此类患者的手术经验。
对2015年12月至2019年4月在本中心接受治疗的20例连续COA合并PA或PD患者进行回顾性研究。仔细呈现手术的基本原则、方法以及短期和中期预后。本文详细介绍个体化治疗方案及其优缺点。
纳入患者病情复杂，其中PA 12例，PD 8例。尽管采用了不同的手术方案，但手术成功率为100%。除2例吻合口出血和1例脊髓损伤外，无其他手术并发症。计算机断层扫描血管造影（CTA）结果显示，9例实现解剖矫正，10例PA或PD不同程度消除或血栓形成，仅1例PA无明显变化。截至随访期，除1例发生轻微脑血管意外和1例PA无变化患者接受了Cheatham Platinum（CP）支架手术外，无其他心血管不良事件发生，所有患者恢复良好。
心脏外科医生和血管内专家共同制定的最佳手术策略，对于COA合并PA或PD患者取得了满意的短期和中期结果。由于病例数量有限，仍有必要进一步研究。
