The use of left heart bypass in adult and recurrent coarctation repair

Abstract

LHB is simple, easy and safe to implement, and is the only technique capable of maintaining independent upper and lower body perfusion pressure. Potentially, it provides the best spinal cord protection, and extends the margin of safety and time to execute an accurate repair.

Results of stent implantation for native and recurrent coarctation of the aorta—follow‐up of up to 13 years

“…Since the first report of surgical management of aortic coarctation in 1945 [1], the results of treatment have improved considerably over the last few decades [2]. However, there is still a significant morbidity associated with surgical repair, the risks of which increase further with repeat surgery for complications or recoarctation [3,4]. The technique of balloon angioplasty was reported in 1982 [5] as an alternative to repeat surgery.…”

Correção cirúrgica da coarctação da aorta em adultos sob assistência circulatória extracorpórea esquerda

“…The prevention of paraplegia should always be decisive in the mind of the surgeon every time the surgery is performed, especially in adult patients [11], which the incidence of paraplegia almost doubles [6]. The lack of development of collaterals that provide an adequate supply to the spinal cord can be determined by clinical circumstances as: primary mild aortic coarctation, recurrent coarctation after surgery (with or without aneurysm), origin of the distal subclavian artery to the coarctation and coarctation after inadequate balloon dilation or stent placement by interventional [12].…”

“…Wong et al [6], between 1997 and 2000, underwent correction of nine cases of aortic coarctation using extracorporeal circulation, but only 3 patients were 18 years old or more. In our series, there was a greater female predominance and the presence of eight cases of coarctation in adults over a period of two years can be explained by the difficulty of early diagnosis in the region.…”

“…In the group of Wong et al [6], the three patients who were operated with ECC had clamping time from 35 to 49 min. In our study, the clamping time was longer, but a similar study using extraanatomic technique with conventional ECC [20].…”

“…The risk of paraplegia is significantly higher in adolescents, adults and recoarctations, with an incidence of 2.6% [6], especially when the collateral circulation is poor. The use of extracorporeal circulation (CPB) for correction of aortic coarctation can help maintain spinal cord perfusion during aortic clamping [7].…”