Aneurysm formation after patch aortoplasty repair (Vossschulte): reoperation in adults with and without hypothermic circulatory arrest.
BACKGROUND
Aortic aneurysm formation is common after patch aortoplasty repair of coarctation of the aorta. Its incidence varies between 5% and 38%. The majority of patients show progressive aneurysmal dilation within 6 to 18 years and reoperation is necessary to avoid rupture of the aneurysm.


METHODS
Ten patients were reoperated on for patch aneurysm formation. Femorofemoral cardiopulmonary bypass (CPB) with a heparinized system was used in all patients. Decision to initiate hypothermic circulatory arrest (HCA) was made intraoperatively. All patients received a Dacron graft replacement of the aneurysmatic thoracic aorta.


RESULTS
HCA was initiated in 5 patients owing to extreme adhesions in vicinity to the aneurysm. There was no significant intergroup difference regarding time interval after first operation, age, operation time, and postoperative blood loss. Only minor neurologic events were present in 2 patients with cross-clamping the aorta.


CONCLUSIONS
Patch aneurysms after Vossschulte aortoplasty can safely be operated on with femorofemoral CPB. Initiation of HCA is recommended to prevent rupture of the aneurysm during preparation and injury of adjacent nerves and vessels.
Roth
Matthias
M
Department of Thoracic and Cardiovascular Surgery, Kerckhoff Clinic Foundation, Bad Nauheim, Germany. matthias.roth@kerckhoffmed.uni-giessen.de
Lemke
Peter
P
Schönburg
Markus
M
Klövekorn
Wolf-Peter
WP
Bauer
Erwin P
EP
D000328:Adult; D001011:Aorta / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D001019:Aortic Rupture / Q000517:prevention & control; D001807:Blood Vessel Prosthesis; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D012086:Reoperation