Operation of mid-arch coarctation.
BACKGROUND
Coarctation occurring within the aortic arch is rare and may present difficulties during surgical repair. We describe the operative technique and outcome in 6 patients with this unusual anomaly.


METHODS
Five patients had antegrade perfusion with circulatory arrest. Three patients with presubclavian narrowing (one presenting with type B dissection) were operated through extended left thoracotomy. Two precarotid and paracarotid lesions were approached through a median sternotomy. All patients were perfused antegradely from the ascending aorta and operated with hypothermic circulatory arrest. One patient who had a complex presubclavian coarctation after two previous repairs received an ascending aorta to abdominal aorta bypass graft without cardiopulmonary bypass.


RESULTS
All patients survived operation and are well at a mean follow-up of 3.3 years after the procedure. None had cerebral problems or spinal cord injury. Renal function was unchanged. The mean (+/- standard error of the mean) resting gradient across the coarctation decreased from 42+/-4.0 mm Hg to 6+/-1.2 mm Hg (p = 0.0004).


CONCLUSIONS
Hypothermic circulatory arrest using antegrade ascending aortic perfusion allows safe and effective repair of mid-arch coarctation. Complicated reoperations can be managed safely using ascending-to-abdominal aortic bypass.
Katsumata
T
T
Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, England. katsu@AHF.org.uk
Westaby
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S
D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome