Deniz Ezin, Bobylev Dmitry, Krüger Heike, Salman Jawad, Zubarevich Alina, Martens Andreas, Kaufeld Tim, Schmack Bastian, Weymann Alexander, Ruhparwar Arjang, Popov Aron-Frederik, Helms Florian
Division for Cardiothoracic-, Transplantation- and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany.
Clinic for Cardiac Surgery, University Clinic Oldenburg, 26133 Oldenburg, Germany.
J Clin Med. 2024 Sep 10;13(18):5345. doi: 10.3390/jcm13185345.
Complications after aortic coarctation repair are associated with high mortality and require surgical or endovascular reintervention. For patients unsuitable for endovascular therapies, reoperation remains the only therapeutic option. However, surgical experience and up-to-date follow-up data concerning this overall rare entity in the spectrum of aortic reoperations are still highly limited. Thus, the aim of this study was to analyze the short-term outcomes and long-term survival of patients undergoing surgical descending aorta repair after previous coarctation repair in a high-volume unit. We present a retrospective single-center analysis of 25 patients who underwent open descending aorta replacement after initial coarctation repair. The surgical history, concomitant cardiovascular malformations, and preoperative characteristics as well as postoperative complications and long-term survival were analyzed. The mean age at operation was 45.4 ± 12.8 years. A proportion of 68% (n = 17) of the patients were male. The most common complication necessitating reoperation after coarctation repair was aneurysm formation (68%) and re-stenosis (16%). The average time between initial repair and reoperation was 26.3 ± 9.9 years. Technical success was achieved in all the operations, while recurrent nerve damage (24%) and bleeding requiring rethoracotomy (20%) were identified as the most common perioperative complications. The one-year mortality was 0% and the overall long-term survival was 88% at 15 years. Open surgical descending aorta replacement can be performed safely and with excellent survival outcomes even in the challenging subgroup of patients after previous coarctation repair. Thus, reoperation should be considered a feasible approach for patients who are unsuitable for endovascular therapies. Nonetheless, concomitant cardiovascular anomalies and frequent preoperations may complicate the redo operation in this patient population.
主动脉缩窄修复术后的并发症与高死亡率相关，需要进行手术或血管腔内再次干预。对于不适合血管腔内治疗的患者，再次手术仍然是唯一的治疗选择。然而，在主动脉再次手术范围内，关于这种总体罕见情况的手术经验和最新随访数据仍然非常有限。因此，本研究的目的是分析在一个高容量单位中，先前接受过缩窄修复的患者进行降主动脉手术修复后的短期结局和长期生存率。我们对25例初次缩窄修复后接受开放降主动脉置换术的患者进行了一项回顾性单中心分析。分析了手术史、伴随的心血管畸形、术前特征以及术后并发症和长期生存率。手术时的平均年龄为45.4±12.8岁。68%（n = 17）的患者为男性。缩窄修复后需要再次手术的最常见并发症是动脉瘤形成（68%）和再狭窄（16%）。初次修复与再次手术之间的平均时间为26.3±9.9年。所有手术均取得技术成功，而喉返神经损伤（24%）和需要再次开胸的出血（20%）被确定为最常见的围手术期并发症。1年死亡率为0%，15年时的总体长期生存率为88%。即使在先前接受过缩窄修复的具有挑战性的患者亚组中，开放手术性降主动脉置换也可以安全进行，并具有出色的生存结局。因此，对于不适合血管腔内治疗的患者，再次手术应被视为一种可行的方法。尽管如此，伴随的心血管异常和频繁的术前情况可能会使该患者群体的再次手术复杂化。
