One-stage surgery for aortic coarctation in adults with concurrent cardiac disease through the ascending aorta to bilateral external iliac arteries bypass
Zhang Liang, Yu Cuntao, Zhao Diancai, Chang Qian, Luo Xinjin, Sun Xiaogang, Wei Bo
Center of Aortic Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital; National Center for Cardiovascular Disease; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
Abstract：Objective To evaluate the efficiency of surgical repair of coarctation of the aorta(CoA) combined with other concomitant cardiac surgery through ascending aorta to bilateral external iliac artery bypass operation.Methods From March 2010 to July 2014, 36 patients with CoA in Fuwai Hospital who were performed ascending aorta to bilateral iliac artery bypass operation combined with other cardiac surgery at one-stage were retrospectively studied. The age was from 25 to 63 years old, the average age was 39, among them, 24 males and 12 females. Average difference in blood pressure the upper and lower limb was (51±7) mmHg (1 mmHg=0.133 kPa)and average systolic pressure of the upper limbs was (165±32) mmHg.The following concomitant procedure were included: aortic valve replacement (8 patients), ventricular septal defect repair (6 patients), Bentall′s procedure (15 patients) and Wheat′s procedure (7 patients). Y-shaped prosthetic vessel graft was used in bypass operation. Research contents after operation included the operation time, blood losing, ICU stay, hospital stay, postoperative complication, early mortality rate, patency rate of graft and rate of reoperation during follow-up. The preoperative and postoperative upper limb blood pressure and differential pressure of upper and lower limbs were analyzed by paired t test. Results All cases were operated uneventfully, operation time ranged from 129 to 223 min, 144 min in average. Blood losing ranged from 250 to 700 mL, average 400 mL, ICU stay 18-46 hours, average 35 hours. Hospitalization period ranged from 9 to15 days, 11 days in average. There was no mortality at early post-operation stage, no complication as renal dysfunction or hepatic dysfunction occurred. All grafts were patent except one case that thrombosis emerged in prosthetic vessel graft on the fifth day after operation. The postoperative upper limb systolic pressure ranged from 118 to 142 mmHg,average(132±26)mmHg (t=2.322, P＜0.05). The average pressure difference of upper and lower limbs ranged from 5 to 15 mmHg, average(10±3)mmHg (t=3.193, P＜0.05). Postoperative follow-up rate was 100%, postoperative follow-up time was 3-55 months, an average of 27 months. There were no mortality and no surgical intervention during the follow-up period. Aortic CT scan was achieved 6-12 months after operation, and 35 patients with bilateral prosthetic vessel unobstructed blood flow. The case that had thrombosis was observed no new thrombosis formation. Conclusions The ascending aorta to bilateral external iliac artery bypass operation combined with other concomitant cardiac surgery is an innovative surgical choice for CoA patient in adults with other cardiac defects. This approach not only simplifies the surgical procedure, reduces the surgical trauma and avoids two-stage surgical intervention, but also has a satisfactory efficacy.
张良,于存涛,赵电彩,常谦,罗新锦,孙晓刚,魏波. 一期开放手术加升主动脉-双髂外动脉旁路术治疗主动脉缩窄合并其他心脏疾病效果观察[J]. 中华解剖与临床杂志, 2016, 21(3): 215-219.
Zhang Liang, Yu Cuntao, Zhao Diancai, Chang Qian, Luo Xinjin, Sun Xiaogang, Wei Bo. One-stage surgery for aortic coarctation in adults with concurrent cardiac disease through the ascending aorta to bilateral external iliac arteries bypass. Chinese Journal of Anatomy and Clinics, 2016, 21(3): 215-219.
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2016, Vol. 21 
