Grinda J M, Macé L, Dervanian P, Folliguet T A, Neveux J Y
Department of Cardiovascular and Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris, France.
Ann Thorac Surg. 1995 Nov;60(5):1299-302. doi: 10.1016/0003-4975(95)00557-2.
Bypass grafting for complex forms of coarctation has been poorly documented as an alternative to decrease the high complication rate associated with anatomic repair.
Between mid-1980 and the end of 1994, 16 patients underwent bypass grafting for complex forms of isthmic aortic coarctation. Age ranged from 11 to 49 years (mean age, 28.4 +/- 13 years). Indications were atypical anatomic forms of coarctation (n = 12) and reoperation after multiple or complicated previous coarctation repair (n = 4). Lateroisthmic bypass grafts were performed in 14 patients and ascending aorta-descending aorta bypass grafts in 2.
There was no hospital mortality. Morbidity consisted of postoperative paradoxical hypertension in 3 patients. There were no spinal cord complications. One death 10 years postoperatively was unrelated to the surgical technique. One patient successfully underwent ascending aorta-descending aorta bypass grafting for a false aneurysm 10 years after lateroisthmic grafting. All patients were asymptomatic and all grafts, patent after a mean follow-up of 5.7 +/- 4 years.
On the basis of these results, bypass grafting appears to be a safe alternative in this select group of patients. The lateroisthmic bypass graft is the procedure of first choice, and the ascending aorta-descending aorta bypass graft should be reserved for failure of previous lateroisthmic bypass grafting.
对于复杂型主动脉缩窄，旁路移植术作为降低与解剖修复相关的高并发症发生率的一种替代方法，相关文献记载较少。
在1980年年中至1994年年末期间，16例患者因复杂型峡部主动脉缩窄接受了旁路移植术。年龄范围为11至49岁（平均年龄28.4±13岁）。手术指征为缩窄的非典型解剖形式（n = 12）以及既往多次或复杂的缩窄修复术后再次手术（n = 4）。14例患者进行了峡部外侧旁路移植术，2例进行了升主动脉-降主动脉旁路移植术。
无住院死亡病例。并发症包括3例术后反常性高血压。无脊髓并发症。术后10年有1例死亡，与手术技术无关。1例患者在峡部外侧移植术后10年因假性动脉瘤成功接受了升主动脉-降主动脉旁路移植术。所有患者均无症状，平均随访5.7±4年后，所有移植血管均通畅。
基于这些结果，旁路移植术在这一特定患者群体中似乎是一种安全的替代方法。峡部外侧旁路移植术是首选术式，升主动脉-降主动脉旁路移植术应留用于既往峡部外侧旁路移植术失败的情况。
