Open anatomical repair for primary coarctation of the aorta in adults
Kyokun Uehara1, Hitoshi Matsuda2, Koki Yokawa1
1Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1, Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan.
Insights
Open anatomical repair effectively treats adult coarctation of the aorta (CoA) and associated cardiac issues. This surgical approach demonstrated no mortality or reintervention during long-term follow-up.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Congenital Heart Disease
Background:
- Endovascular repair is an alternative for adult coarctation of the aorta (CoA).
- Open repair allows simultaneous correction of associated cardiac complications.
- These complications include aneurysms and intracardiac defects.
Purpose of the Study:
- To evaluate the outcomes of open anatomical repair for adult coarctation of the aorta.
- To assess the efficacy of surgical repair in patients with complex aortic and intracardiac lesions.
Main Methods:
- Eleven adult patients (21-63 years) underwent primary open coarctation of the aorta repair.
- Surgical approaches included left thoracotomy (n=8) and total arch replacement (n=3) via median sternotomy or combined approaches.
- Comorbidities included descending aorta aneurysm (45.5%), ascending aorta aneurysm (27.3%), and valvular abnormalities.
Main Results:
- No in-hospital mortality or spinal cord ischemia was observed.
- One patient required prolonged ventilation (>48 hours) after combined sternotomy and thoracotomy.
- During a median follow-up of 90 months, no deaths or reinterventions were reported.
Conclusions:
- Open anatomical repair is a viable option for adult coarctation of the aorta.
- Surgical techniques, including median sternotomy, left thoracotomy, or combined approaches, can address complex aortic and intracardiac pathologies.
- This approach offers durable results without the need for reintervention.
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.
