Single-stage correction of aortic coarctation combined with an aneurysm of the ascending portion of the aorta and/or intracardiac pathology in adults

Rosseikin E.V., Evdokimov M.E., Bazylev V.V., Vachev S.A.

Cardiosurgical Department No 2, Anaesthesiology and Resuscitation Division No 1, Federal Centre for Cardiovascular Surgery under the Russian Federation Public Health Ministry, Penza, Russia

Objective: the work was aimed at substantiating and studying the outcomes of single-stage correction of aortic coarctation combined with an aneurysm of the ascending portion of the aorta and/or intracardiac pathology in adult patients.

Materials and methods. From August 2009 to September 2012, a total of nine patients were operated on for aortic coarctation combined with an aneurysm of the ascending portion of the aorta and/or intracardiac pathology. The patient’s average age amounted to 35.6±15 years. The risk median according to the Euroscore scale equalled 9.35 % (7 points). Aortic coarctation was corrected by means of ascending-to-descending bypass grafting of the aorta, simultaneously accompanied by prosthetic repair of the ascending portion of the aorta and/or correction of cardiac pathology from the median sternotomy approach.

Results. The mean duration of artificial circulation amounted to 178.7±25.5 min, with that of myocardial ischaemia equalling 133.7±29.4 min. The average volume of blood loss was 616.6±325 min. The postoperative follow-up period ranged from two months to three years. No lethal outcomes were observed. The clinical manifestation of hypertension regressed in all patients. There were no cases of either dislocation of the ascending-descending bypass graft or compression of the surrounding formations thereby.

Conclusions. The presented technique of single-stage surgical correction of aortic coarctation combined with an aneurysm of the ascending aorta and/or intracardiac pathology in adult patients makes it possible to perform all technical manipulations during a single-step surgical intervention from one approach, i. e. sternotomy.

Placing the aorto-aortic graft behind the inferior vena cava toward the front of the right pulmonary veins makes it possible to minimize the risks associated with an extra-anatomical position of the prosthesis.

KEY WORDS: aortic coarctation, aneurysm of the ascending portion of the aorta, bicuspid aortic valve, ascending-to-descending bypass grafting, aorto-aortic graft.

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