Surgical repair of coarctation of aorta in adults under left heart bypass.

OBJECTIVE: To describe our experience with repair of coarctation of the aorta in adults using left heart bypass. METHODS: From November 2007 to October 2009, eight adult patients with coarctation of the aorta underwent surgical repair under circulatory support using a left atrium to femoral artery bypass circuit, with graft interposition tube through left posterolateral thoracotomy. Five patients were female, with mean age of 31.5 ± 13.1 years. All patients had hypertension and others associated cardiovascular diseases. RESULTS: There were no deaths or neurological complications. The mean surgical time was 308 minutes with mean left heart bypass and distal aortic clamping time of 73 and 65 minutes respectively. Postoperative bleeding was 696 ml in average. Six patients developed severe hypertension postoperatively requiring intravenous vasodilators. The mean length of stay was 9 days. A significant reduction of gradient blood pressure occurred. Echocardiographic follow-up up to two months postoperatively showed mean aortic / graft gradient of 20.3 mmHg. CONCLUSION: In this series the use of left heart bypass showed to be a safe option in the surgical correction of coarctation of the aorta in adults, especially in patients with abnormal aortic wall. There was no spinal cord ischemia in the cases studied.

Correção cirúrgica da coarctação da aorta em adultos sob assistência circulatória extracorpórea esquerda / Surgical repair of coarctation of aorta in adults under left heart bypass

OBJETIVO: Descrever a experiência do serviço com a correção da coarctação da aorta em adultos utilizando assistência circulatória esquerda. MÉTODOS: De novembro de 2007 a outubro de 2009, oito pacientes adultos com coarctação da aorta foram submetidos a correção cirúrgica com interposição de enxerto tubular através de toracotomia póstero-lateral esquerda e uso de assistência circulatória com uso de circuito átrio esquerdo e artéria femoral. Cinco pacientes eram do sexo feminino e tinham idade média de 31,5 ± 13,1 anos. Todos tinham hipertensão arterial sistêmica (HAS) e apresentavam doenças cardiovasculares associadas. RESULTADOS: Não houve óbitos ou complicações neurológicas. O tempo médio cirúrgico foi de 308 minutos, o tempo médio de assistência circulatória de 73 minutos e o de pinçamento aórtico médio de 65 minutos. O sangramento médio no pós-operatório foi de 696 ml. Seis pacientes evoluíram com HAS grave no pós-operatório, sendo necessário uso de vasodilatadores endovenosos. As altas hospitalares ocorreram em média no 9º dia pós-operatório. Houve redução significativa do gradiente médio da pressão arterial sistêmica. O seguimento ambulatorial com ecocardiograma até dois meses de pós-operatório demonstrou gradiente aorta/enxerto médio de 20,3 mmHg. CONCLUSÃO: O uso da assistência circulatória esquerda pode ser uma opção na correção cirúrgica da coarctação da aorta em adultos, principalmente em pacientes com alterações parede da aorta, não sendo observada isquemia medular nos casos estudados.

OBJECTIVE: To describe our experience with repair of coarctation of the aorta in adults using left heart bypass. METHODS: From November 2007 to October 2009, eight adult patients with coarctation of the aorta underwent surgical repair under circulatory support using a left atrium to femoral artery bypass circuit, with graft interposition tube through left posterolateral thoracotomy. Five patients were female, with mean age of 31.5 ± 13.1 years. All patients had hypertension and others associated cardiovascular diseases. RESULTS: There were no deaths or neurological complications. The mean surgical time was 308 minutes with mean left heart bypass and distal aortic clamping time of 73 and 65 minutes respectively. Postoperative bleeding was 696 ml in average. Six patients developed severe hypertension postoperatively requiring intravenous vasodilators. The mean length of stay was 9 days. A significant reduction of gradient blood pressure occurred. Echocardiographic follow-up up to two months postoperatively showed mean aortic / graft gradient of 20.3 mmHg. CONCLUSION: In this series the use of left heart bypass showed to be a safe option in the surgical correction of coarctation of the aorta in adults, especially in patients with abnormal aortic wall. There was no spinal cord ischemia in the cases studied.