Total Simultaneous Repair of Coarctation and Intracardiac Pathology in Adult Patients

• Published in: The Annals of thoracic surgery Vol. 65; no. 6; pp. 1698 - 1702
• Main Authors: Morris, Rohinton J, Samuels, Louis E, Brockman, Stanley K
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.1998; Elsevier Science
• Subjects: Adrenergic alpha-Agonists - therapeutic use; Aged; Aorta, Thoracic - abnormalities; Aorta, Thoracic - surgery; Aortic Coarctation - surgery; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Biological and medical sciences; Blood Pressure - drug effects; Blood Vessel Prosthesis Implantation; Cardiac Output, Low - surgery; Catheterization; Coronary Artery Bypass; Coronary Disease - surgery; Heart Arrest, Induced - methods; Heart Diseases - surgery; Heart Transplantation; Heart Valve Prosthesis Implantation; Humans; Male; Medical sciences; Middle Aged; Safety; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Human; Aortic coarctation; Cardiovascular disease; Congenital disease; Result; Vascular disease; Thoracic aorta; Concomitant disease; Treatment; Combined surgery; Malformation; Surgery; Heart disease; Technique; Repair; Aortic disease
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(98)00291-4

Background. Thoracic aortic coarctation accompanied by a second surgically reparable lesion is a rare combination in the adult patient. The simultaneous operative management of both lesions is desirable because of the higher morbidity and mortality that would occur with staged procedures. Methods. We describe the simultaneous operative management in three adult patients with coarctation and a second cardiac lesion. All 3 patients had intrapericardial ascending aorta–descending aorta bypass and concomitant repair of a cardiac lesion. The attendant repairs in the 3 patients, respectively, were aortic valve replacement, orthotopic heart transplantation, and coronary artery bypass grafting. Results. Double arterial cannulation, retrograde cardioplegia, large-bore aorto–aortic bypass grafts, and early use of α-agonists to stabilize systemic pressure were all key to ensuring safe conduct of the operation. Each patient had an essentially uneventful postoperative course. Conclusions. Thoracic coarctation and concomitant cardiac pathology can be safely and readily managed with a single-stage approach involving cardiac repair and extraanatomic ascending aorta–descending aorta bypass grafting. A review of the English-language literature of patients managed similarly is included.