Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-24T13:14:04.215Z Has data issue: false hasContentIssue false
  • English
  • Français

Results of using cardiopulmonary bypass for spinal cord protection during surgical repair of complex aortic coarctation*

Published online by Cambridge University Press:  07 February 2013

Stany Sandrio ,
Matthias Karck ,
Matthias Gorenflo  and
Tsvetomir Loukanov
Stany Sandrio*
Affiliation:
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Matthias Karck
Affiliation:
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
Matthias Gorenflo
Affiliation:
Department of Paediatric Cardiology, University of Heidelberg, Heidelberg, Germany
Tsvetomir Loukanov
Affiliation:
Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
*
Correspondence to: Dr S. Sandrio, MD, Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Tel: +49 6221 56 37981; Fax: +49 6221 56 5585; E-mail: [email protected]; [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The aim of this study was to evaluate the surgical treatment of complex aortic coarctation using partial cardiopulmonary bypass to increase the spinal cord protection.

Methods

A total of 15 patients (age range from 7 to 48 years) underwent coarctation repair through a left posterolateral thoracotomy with cardiopulmonary bypass. Cannulation was performed via the descending aorta and the main pulmonary artery. In all, six surgeries were performed under hypothermic circulatory arrest and nine repairs were performed under mild hypothermia. The clinical outcome regarding the development of restenosis, as well as major neurologic complication, was studied.

Results

There was no mortality. None of the patients developed paraplegia. Of the 15 patients, two developed a recurrent stenosis at the proximal anastomosis between the aortic arch and the aortic prothesis at a mean follow-up of 5.5 years. In the remaining 13 patients, echocardiography and magnetic resonance imaging showed no evidence of a significant gradient.

Conclusion

Complex aortic coarctation without hypoplasia of the proximal aortic arch and intra-cardiac anomalies can be repaired with low mortality and neurologic morbidity via a left thoracotomy using cardiopulmonary bypass. The use of cardiopulmonary bypass goes along with a low risk of spinal cord and lower body ischaemia and provides a sufficient amount of time for the anastomoses.

Keywords

Coarctationaortic operationcardiopulmonary bypass
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 1 , February 2014 , pp. 113 - 119
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

46th Annual Meeting of the Association for European Paediatric and Congenital Cardiology, 24 May 2012, Istanbul, Turkey; 41st Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, 13 February 2012, Freiburg, Germany

References

1. Baumgartner, H, Bonhoeffer, P, Groot, NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31: 2915–2957.Google Scholar
2. Lee, B. Beerman. Coarctation of the aorta. The Merck manuals. Retrieved March 2009, from http://www.merckmanuals.com/professional/pediatrics/congenital_cardiovascular_anomalies/coarctation_of_the_aorta.html.Google Scholar
3. Jurcut, R, Daraban, AM, Lorber, A, et al. Coarctation of the aorta in adults: what is the best treatment? Case report and literature review. J Med Life 2011; 4: 189–195.Google Scholar
4. Tanous, D, Collins, N, Dehghani, P, Benson, LN, Horlick, EM. Covered stents in the management of coarctation of the aorta in the adult: initial results and 1-year angiographic and hemodynamic follow-up. Int J Cardiol 2010; 140: 287–295.CrossRefGoogle ScholarPubMed
5. Luijendijk, P, Boekholdt, SM, Blom, NA, et al. Percutaneous treatment of native aortic coarctation in adults. Neth Heart J 2011; 19: 436–439.Google Scholar
6. Rosenthal, E. Coarctation of the aorta from fetus to adult: curable condition or life long disease process? Heart 2005; 91: 1495–1502.CrossRefGoogle ScholarPubMed
7. van Heurn, LWE, Wong, CM, Spiegelthaler, DJ, et al. Surgical treatment of aortic coarctation in infants younger than three months: 1985 to 1990. J Thorac Cardiovasc Surg 1994; 107: 74–86.Google Scholar
8. Knapp, J, Bernhard, M, Rauch, H, Hyhlik-Dürr, A, Böckler, D, Walther, A. Anesthesiologic procedure for elective aortic surgery. Anaesthesist 2009; 58: 1161–1182.Google Scholar
9. Berendes, JN, Bredée, JJ, Schipperheyn, JJ, Mashhour, YA. Mechanisms of spinal cord injury after cross-clamping of the descending thoracic aorta. Circulation 1982; 66 (Pt 2): I112–I116.Google Scholar
10. Fedorow, CA, Moon, MC, Mutch, WA, Grocott, HP. Lumbar cerebrospinal fluid drainage for thoracoabdominal aortic surgery: rationale and practical considerations for management. Anesth Analg 2010; 111: 46–58.Google Scholar
11. Estrera, A, Sheinbaum, R, Miller, C, et al. Cerebrospinal fluid drainage during thoracic aortic repair: safety and current management. Ann Thorac Surg 2009; 88: 9–15.Google Scholar
12. Crawford, ES, Svensson, LG, Hess, KR, et al. A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg 1991; 13: 36–45.CrossRefGoogle ScholarPubMed
13. Wong, CH, Watson, B, Smith, J, Hamilton, JR, Hasan, A. The use of left heart bypass in adult and recurrent coarctation repair. Eur J Cardiothorac Surg 2001; 20: 1199–1201.Google Scholar
14. Backer, CL, Stewart, RD, Kelle, AM, Mavroudis, C. Use of partial cardiopulmonary bypass for coarctation repair through a left thoracotomy in children without collaterals. Ann Thorac Surg 2006; 82: 964–972.Google Scholar
15. Buckels, NJ, Willetts, RG, Roberts, KD. Left heart bypass in the surgery of aortic coarctation in children. Thorax 1988; 43: 1003–1006.Google Scholar
16. Pennington, DG, Liberthson, RR, Jacobs, M, Scully, H, Goldblatt, A, Daggett, WM. Critical review of experience with surgical repair of coarctation of the aorta. J Thorac Cardiovasc Surg 1979; 77: 217–229.Google Scholar
17. Ravindranath, KS, Moorthy, N, Palaneeselvam, A, Dwarakaprasad, R, Satish, K, Manjunath, CN. A clinically masked normotensive aortic coarctation. Indian Heart J 2010; 62: 363–364.Google Scholar
18. Hamawaki, M, Narimatsu, M, Yamaguchi, H, Nishi, K, Eishi, K. Bilateral subclavian steal associated with severe coarctation of the thoracic aorta and an aberrant right subclavian artery. Jpn J Thorac Cardiovasc Surg 2003; 51: 110–112.Google Scholar
19. Lange, R, Thielmann, M, Schmidt, KG, et al. Spinal cord protection using hypothermic cardiocirculatory arrest in extended repair of recoarctation and persistent hypoplastic aortic arch. Eur J Cardiothorac Surg 1997; 11: 697–702.Google Scholar
20. Coselli, JS, Bozinovski, J, Cheung, C. Hypothermic circulatory arrest: safety and efficacy in the operative treatment of descending and thoracoabdominal aortic aneurysms. Ann Thorac Surg 2008; 85: 956–963.CrossRefGoogle ScholarPubMed