Objective To summarize the experiences of the surgical management for adult patients with aortic coarctation. Methods Clinical data of 40 adult patients diagnosed with aortic coarctation undergoing surgical repair in our center between July 2004 and March 2015 were retrospectively analyzed. There were 28 males and 15 females with a mean age of 26.3±11.0 years (ranging 16-57 years). We evaluated the effect of surgery by the change of pressure gradient between upper limb and lower limb, mechanical ventilation time, and length of ICU stay and hospital stay. Results Forty surgeries were finished successfully. One patient died after surgery. The follow-up ranged from 12 to 36 months. The mean pressure gradient reduced significantly after surgery. There were 6 patients suffering blood hypertension at their discharge, and all of them still need antihypertensive drugs. Conclusion Surgical repair is an effective treatment for adult with aortic coarctation. Extra-anatomic ascending-to-descending aortic bypass and concomitant repair of intracardiac anomalies is safe and effective.
ObjectiveTo summarize the clinical experience of the treatment for complex aortic coarctation with extra anatomic bypass and anatomic correction techniques. MethodsThe clinical data of patients with complex aortic coarctation treated in the First Affiliated Hospital of Nanjing Medical University and Friendship Hospital of Ili Kazakh Autonomous Prefecture between April 2012 and November 2020 were retrospectively reviewed. ResultsA total of 12 patients were enrolled, including 5 males and 7 females aged 11-54 (34.3±16.2) years. Extra anatomic bypass grafting was performed in 8 patients and anatomic correction was performed in 4 patients. The operations were successful in all patients. There was no perioperative death. The average cardiopulmonary bypass time was 203.0±46.0 min (7 median incision patients), and the average intraoperative blood loss was 665.0±102.0 mL. The average postoperative ventilator support time was 32.3±7.5 h, and the average postoperative hospital stay time was 10.2±4.3 d. The mean drainage volume of median incision was 1 580.0±360.0 mL, and the mean drainage time was 9.3±2.7 d. The mean drainage volume of left thoracotomy was 890.0±235.0 mL, and the mean drainage time was 4.8±2.5 d. One patient had a transient hoarse after operation and recovered 6 months later. The follow-up period ranged from 2 to 10 years with an average time of 81.0±27.0 months. All patients had a recovery of hypertension, cardiac afterload after 2 years postoperatively. One patient who received an artificial blood vessel replacement in situ was examined stenosis recurrence at the third year after discharge. Others were asymptomatic during the follow-up period. There were no death or other complications. ConclusionThe treatment strategy for complex aortic coarctation should be individualized according to the anatomical features and concomitant heart diseases. Extra anatomic bypass technique is a safe and feasible choice.
Objective A meta-analysis was performed for a comparison of outcomes between surgery and balloon angioplasty (BA) for native coarctation of the aorta (NCA) in pediatric patients. Methods Electronic databases, including PubMed, EMbase, Medline, Cochrane Library, Weipu Data, Wanfang Data and CNKI were searched systematically for the literature aimed mainly at comparing the therapeutic effects for NCA administrated by surgery and BA. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Results Ten studies meeting the inclusion criteria were included, involving a total of 723 subjects. It was observed that compared with BA, surgery was significantly associated with a lower incidence of recoarctation (OR, 0.43; 95%CI, 0.30–0.63; P<0.001), repeat intervention due to recoarctation (OR, 0.40; 95%CI, 0.27–0.61;P<0.001) and lower residual transcoarctation gradient in mid to long term follow up (WMD –0.85; 95%CI, –12.34 to –3.76;P<0.001). Compared with BA, surgery was significantly associated with a longer hospitalization time (WMD, 19.40; 95%CI, 15.82–22.99;P<0.001). Incidence of aneurysm formation (OR, 0.64; 95%CI, 0.26–1.57;P=0.33), complications(OR, 1.77; 95%CI, 0.95–3.28; P=0.07), perioperative mortality (OR, 2.57; 95%CI, 0.87–7.61, P=0.09) and immediate transcoarctation residual gradient (WMD –1.66; 95%CI, –4.23–0.90; P=0.2) were not statistically different between surgery and BA. Conclusions Compared with BA, surgery was significantly associated with a lower incidence of recoarctation, repeat intervention due to re-CoA and residual transcoarctation gradient in mid to long term follow up. On the contrary, BA was significantly associated with a shorter hospitalization time. Incidence of aneurysm formation, perioperative mortality, complications and immediate transcoarctation residual gradient were similar between surgery and BA.
ObjectiveTo evaluate the effectiveness of covered Cheatham-platinum (CP) stent for treatment of coarctation of aorta (CoA). MethodsBetween January 2007 and September 2013, 15 patients (16 lesions) with CoA underwent covered CP stent implantation, and the clinical data were analyzed retrospectively. Of 15 cases, 8 were male and 7 were female, aged 13-56 years (mean, 27.7 years). Fifteen lesions located beyond the origin of the left subdavian artery, and 1 lesion located between the origin of the left common carotid artery and the origin of the left subdavian artery. Proper covered CP stent and balloon-in-balloon (BIB) catheter were selected according to the data of computed tomography angiography or digital subtraction angiography examination. Under fluoroscopic guidance, the covered CP stent was placed at lesion accurately by expanding the inner balloon and the outer balloon sequentially. The variation of the systolic pressure gradient across the lesion and the stenosis extent of the aorta before and after the procedure were recorded. ResultsFifteen patients were all treated by covered CP stent implantation successfully. The systolic pressure gradient across the lesion decreased from (58.1±19.5) mm Hg (1 mm Hg=0.133 kPa) at preoperation to (6.2±5.6) mm Hg at immediate after CP stent implantation, and the stenosis extent of the aorta decreased from 73.8%±12.8% at preoperation to 16.7%±5.6% at immediate after CP stent implantation, all showing significant difference (t=12.483, P=0.000; t=15.631, P=0.000). All puncture points healed well with no aortic dissection, pseudoaneurysm, or obvious subcutaneous hematoma. All the patients could walk moderately within 48 hours after procedure. The average hospitalization time was 11.1 days (range, 6-18 days). During a mean follow-up of 29.7 months (range, 1-81 months), the symptom of dizziness and exercise tolerance were improved obviously, and the systolic pressures gradient between upper and lower extremity was below 20 mm Hg. The systolic and diastolic pressures at last follow-up were significantly improved when compared with preoperative values (t=7.725, P=0.000; t=3.651, P=0.000). According to radiography, the location and shape of the stent were good, and no aortic dissection, aneurysm, or recoarctation occurred. ConclusionAccording to the initial and midterm results, the covered CP stent is an effective treatment for CoA in adolescents and adults with a low rate of complication. However, long-term results still require further follow-up.
ObjectiveTo explore the role of increased preoperative ventricular-arterial stiffening in hypertensive infants with coarctation of the aorta (CoA).MethodsA retrospective study was conducted in 314 infants with CoA (CoA group, 193 males and 121 females, aged 5.4±2.2 months), and 314 infants receiving tumor chemotherapy with normal cardiovascular function and without pneumonia (control group, 189 males and 125 females, aged 4.4±3.8 months), who were admitted to our hospital from 2015 to 2017. The clinical data of the two groups were compared.ResultsThere were statistical differences in effective aortic elastance index (Eai), effective left ventricular end-systolic elasticity index (Eesi), ventricle-artery coupling index (VACi), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and ratios of left ventricular hypertrophy, dilation and systolic dysfunction between the two groups (P<0.05). Compared with non-hypertensive CoA infants, CoA infants with hypertension had higher Eai, Eesi, NT-ProBNP level and proportion of left ventricular hypertrophy (P<0.05). Compared with concomitant ventricular septal defect, infants with isolated CoA had higher Eai, Eesi, NT-proBNP level, incidence of hypertension and higher proportion of left ventricular hypertrophy, dilation and systolic dysfunction (P<0.05). Eai and Eesi were positively correlated with NT-proBNP level, left ventricular hypertrophy and fractional shortening of left ventricle (P<0.05), while Eai and Eesi were negatively correlated with left ventricular end diastolic volume index, left ventricular end systolic volume index and concomitant ventricular septal defect (P<0.05). Hypertension was related to preoperative left ventricular hypertrophy, Eai, Eesi and NT-ProBNP. Eai was an independent risk factor for hypertension.ConclusionPreoperative ventricular-arterial stiffening is increased in infants with aortic coarctation, which is related to the occurrence of hypertension. Isolated CoA shows more significant increase in ventricular-arterial stiffening, higher ventricular overload and incidence of hypertension.
Currently, transcatheter intervention has emerged as a first-line treatment for coarctation of the aortic. Due to the radiation exposure associated with catheter interventional therapy, there are numerous restrictions, which harms both patients and medical personnel and is dependent on sizable radiation apparatus. Here, we report for the first time a case of echo-guiding percutaneous aortic stent implantation for a 27 years female patient of reproductive age. After discharge, the patient's aortic coarctation pressure decreased to 18 mm Hg, and the surgical results were satisfactory.
Objective To explore of a surgical approach of posterior pericardial ascending-to-descending aortic bypass through a median sternotomy for complex coarctation and interrupted aortic arch adult patients with coexistent cardiac disorder. Methods We retrospectively reviewed the clinical data of 2 adult patients with complex coarctation and 1 adult patient with interrupted aortic arch and all with coexistent cardiac disorder who underwent ascending-to-descending aortic bypass in our hospital between April 2010 and January 2015. There were 2 males and 1 female with age of 35.6 (27-46) years. One patient was with complex coarctation, and prolapse of anterior mitral leaflet with moderate regurgitation. One patient was with complex coarctation, and bicuspid aortic valve with severe aortic regurgitation, and ascending aortic aneurysm. One patient was with interrupted aortic arch (type A), and bicuspid aortic valve with mild stenosis, and secundum atrial septal defect. The surgical approach used in all patients was the median sternotomy. After aorta, femoral artery and bicaval cannulation, hypothermic cardiopulmonary bypass was established. With posterior pericardial ascending-to-descending aortic bypass procedure for repair of complex coarctation and interrupted aortic arch with coexistent cardiac disorder. Results There was no death. The symptoms of the patients obviously improved. All the patients were alive with ascending-to-descending aortic bypass procedure at a mean follow-up ranged from 2 to 59 months. Except that one patient had residual upper-extremity hypertension, and needed antihypertensive medications taken postoperatively, other patients’ systolic blood pressure returned to normal level. All patients’ lower-extremity fatigability resolved. Postoperative computed tomography angiography (CTA) of the patients showed that dacron graft was unobstructed with no graft-related complications of kinking and narrowing, development of false aneurysms or other complications. Conclusion The surgical management of adult patients’ complex coarctation and interrupted aortic arch with coexistent cardiac disorder, a one-stage approach using pericardial ascending-to-descending aortic bypass through a median sternotomy is an alternative surgery.
Abstract： Objective To investigate the clinical results of offpump anatomic surgical repair for complex coarctation in adults. Methods We retrospectively analyzed the clinical data of 7 patients with complex coarctation who underwent onestage anatomic surgical repair between January 2005 and December 2008 in Fu Wai Hospital. There were 5 males and 2 females with the age ranged from 16 to 41 years, average at 24.4 years. Among all the patients, there were 2 patients of coarctation with hypoplastic aortic arch, 1 of coarctation with aortic arch aneurysm, 3 of coarctation with descending thoracic aortic aneurysm, and 1 of coarctation with B type aortic dissection. All patients were diagnosed by color echocardiography, CT or agnetic resonance imaging（MRI）. All off-pump operations were performed under general anesthesia and ambient temperature. Median sternotomy was performed in 1 patient and left thoracotomy in 6 patients. Aortic arch patching enlargement was performed in 4 patients and descending thoracic aorta replacement in 3 patients (including 1 combined with abdominal aorta replacement and 1 case of Stanford B type aortic dissection, trunk stent was transplanted at the same time). Results There was no hospital mortality or severe surgical complications. Seven patients were followed up for a period ranged from 6 to 49 months with an average time of 20.1 months. No late death or recoarctation occurred. Hoarseness occurred in one patient and presented no improvement during the 11 months follow-up. Conclusion Onestage offpump anatomic surgical repair is safe and feasible in treating adult patients with complex coarctation, and it shows a good immediate and longterm result.