One-stage repair for adults aortic coarctation concomitant with cardiac diseases: ascending aorta-abdominal aorta by-pass combined with cardiac operation / 中华胸心血管外科杂志

Objective Evaluate the surgical result of ascending aorta-abdominal aorta bypass combined with cardiac op-eration for adults aortic coarctation concomitant with cardiac diseases.Methods Between February 2009 and September 2012, total 24 consecutive patients underwent ascending aorta-abdominal aorta bypass combined with cardiac operation.Of these pa-tients, 2 patients who underwent off-pump coronary artery bypass grafting combined with ascending aorta-abdominal aorta by-pass did not required cardiopulmonary bypass.Other 22 patients underwent one stage repair under cardiopulmonary bypass. The mean artery pressure of upper-lower limb was(38.0 ±9.34)mmHg.Results There was no in-hospital mortality.The mean artery pressure of upper-lower limb was(11.44 ±2.59)mmHg.The mean cardiopulmonary bypass time was(107.27 ± 34.56) min.The mean aorta clamp time was(72.59 ±28.98)min.The mean intensive care unit stay time is(35.22 ± 50.41)h.The mean mechanical ventilation time was(19.50 ±17.64)h.2 patients required prolonged mechanical ventilation for respiratory dysfunction.Of these 2 patients, 1 patient required ECMO support for respiratory failure.Total 1 patient needed temporary continuous renal replacement therapy.No re-exploration for bleeding and gastrointestinal complications were ob-served.Aorta CTA scan was performed for all patients before discharged from hospital.The grafts were patent for all patients and no graft-related complications were observed.Conclusion Ascending aorta-abdominal aorta bypass combined with cardiac operation is a safe and effective one stage repair technique for adults aortic coarctation concomitant with cardiac diseases is a safe and effective technique.

A Case of Ascending Aorta-Abdominal Aorta Bypass with Reconstruction of the Visceral Arteries for Atypical Coarctation / 日本心臓血管外科学会雑誌

A 51-year-old man was referred to us because of upper extremity hypertension and vascular claudication of the lower extremities. He underwent extraanatomic ascending aorta-abdominal aorta bypass with vascular graft under a median sternotomy and a midline laparotomy incision without cardiopulmonary bypass. The postoperative course was uneventful. Upper extremity hypertension and vascular claudication were completely resolved. Although the patient has done well in the three years since his operation, we continue to observe him closely. The etiology of atypical coarctation may be related to Takayasu arteritis because of the angiographic findings and positive specific alleles such as HLA-B5201 and DRB1 1502.