Kristofer M. Charlton-Ouw, Maria E. Codreanu, Samuel S. Leake, Harleen K. Sandhu, Daniel Calderon, Ali Azizzadeh, Anthony L. Estrera, Hazim J. Safi
Department of Cardiothoracic and Vascular Surgery, University of Texas at Houston Medical School, Houston, TX.
OBJECTIVES: Aortic coarctation is one of the most common congenital aortic lesions and is usually repaired in early childhood. Without correction, death often occurs before the fourth decade and surviving adults suffer from hypertension and other complications from poor distal flow. We report on our experience with open repair of aortic coarctation in adults.
METHODS: We retrospectively reviewed all patients age >16 years requiring open repair (de novo and redo) of aortic coarctation. Our protocol for spinal cord protection includes distal aortic perfusion via aortofemoral bypass, moderate passive hypothermia, and cerebrospinal fluid drainage. Indications for repair, operative details, and outcomes were analyzed.
RESULTS: Between 1999 and 2011, we treated 30 patients with adult aortic coarctation. The median age was 40 years (range 17-69) and there were 16 males. Eight patients had previous repair with recurrence; 22 patients had native coarctation. Aortic aneurysm was present in 20 patients (67%), ranging in size from 2.6-9.6 cm. The most common repair was resection of aortic coarctation with interposition graft replacement (n=26). Other repairs included bypass from proximal descending thoracic aorta to the infrarenal aorta (n=2); and ascending, arch, and proximal descending aortic replacement via median sternotomy (n=2). Complications occurred in 7 patients (23%), including chylous effusion (n=2), recurrent laryngeal nerve injury (n=1), acute renal failure (n=1), respiratory failure (n=1), atrial fibrillation (n=1), and urinary tract infection (n=1). In-hospital mortality was 0%. There were no cases of immediate or delayed neurologic deficit. Death occurred in 3 patients during follow-up (mean 19 months, range 1-231); none were related to coarctation repair. One patient (3%) required reoperation 6 years later due to aneurysm formation distal to the initial repair.
CONCLUSIONS: Open repair of adult aortic coarctation has acceptable morbidity, low mortality, and excellent durability.
AUTHOR DISCLOSURES: A. Azizzadeh, Nothing to disclose; D. Calderon, Nothing to disclose; K. M. Charlton-Ouw, Nothing to disclose; M. E. Codreanu, Nothing to disclose; A. L. Estrera, Nothing to disclose; S. S. Leake, Nothing to disclose; H. J. Safi, Nothing to disclose; H. K. Sandhu, Nothing to disclose.
Posted April 2012