Objectives

Although endovascular repair has become an alternative treatment for coarctation of the aorta (CoA) in adults, open repair provides concomitant repair of other cardiac complications, including post-stenotic aneurysm, ascending aortic aneurysm, and intracardiac diseases. We evaluated open anatomical repair for CoA repair in adults.

Methods

Eleven patients (6 men, age range 21–63 years) underwent primary CoA repair. Complicating conditions included post-stenotic aortic aneurysm in the descending aorta in 5 patients (45.5%) and ascending aortic aneurysm in 3 (27.3%). Two patients (18.2%) had a bicuspid aortic valve, and one (9.1%) had a quadricuspid aortic valve. Ventricular septal defect was detected in 1 patient (9.1%). Eight patients (72.7%) underwent descending aorta replacement through a left thoracotomy, comprising partial cardiopulmonary bypass in 4 and deep hypothermic circulatory arrest in 4. Of those, the left subclavian artery was reconstructed in 4 patients. The remaining 3 patients (27.3%) underwent total arch replacement, through a median sternotomy in 1 and using a combination of median sternotomy and thoracotomy in 2.

Results

No in-hospital mortality was observed. No spinal cord ischemia or neurological events were encountered, but 1 patient (9.1%) who underwent CoA repair via median sternotomy and thoracotomy required prolonged ventilatory support for more than 48 h. During the follow-up of 90 months (interquartile range 65–124 months), no patient died or required reintervention for the repaired segment.

Conclusions

CoA in adults could be anatomically repaired with graft replacement both through the median sternotomy, the left thoracotomy, and the combination of both approaches, according to the complicated aortic or intracardiac lesions.

中文翻译：

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成人主动脉原发性缩窄的开放解剖修复

目标

尽管血管内修复已成为成人主动脉缩窄 (CoA) 的替代治疗方法，但开放修复可同时修复其他心脏并发症，包括狭窄后动脉瘤、升主动脉瘤和心内疾病。我们评估了成人 CoA 修复的开放解剖修复。

方法

11 名患者（6 名男性，年龄范围 21-63 岁）接受了初级 CoA 修复。并发症包括 5 名患者 (45.5%) 的降主动脉狭窄后主动脉瘤和 3 名 (27.3%) 的升主动脉瘤。2 名患者 (18.2%) 有二尖瓣主动脉瓣，1 名 (9.1%) 有四尖瓣主动脉瓣。1 名患者 (9.1%) 检测到室间隔缺损。8 名患者（72.7%）通过左开胸手术行降主动脉置换术，其中 4 名部分体外循环，4 名深低温停循环。其中 4 名患者重建了左锁骨下动脉。其余 3 名患者 (27.3%) 接受了全弓置换术，1 名通过正中胸骨切开术，2 名使用正中胸骨切开术和开胸术相结合。

结果

未观察到院内死亡。没有遇到脊髓缺血或神经系统事件，但 1 例 (9.1%) 通过正中胸骨切开术和开胸术接受 CoA 修复的患者需要长时间的通气支持超过 48 小时。在 90 个月的随访期间（四分位距为 65-124 个月），没有患者死亡或需要对修复的节段进行再次干预。

结论

根据复杂的主动脉或心内病变，成人的 CoA 可以通过正中胸骨切开术、左侧开胸术和两种方法的组合，通过移植物置换在解剖学上修复。