Preliminary Experience With Custom Made Hourglass Shaped Thoracic Stent Grafts for Endovascular Thoracic Aortic Coarctation Repair in Adults

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

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Spinal cord injury associated with hyperthermia during aortic coarctation repair

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(19)37365-9 ◽

1984 ◽

Vol 87 (4) ◽

pp. 616-618 ◽

Cited By ~ 30

Author(s):

Fred A. Crawford ◽

Robert M. Sade

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Aortic Coarctation ◽

Coarctation Repair ◽

Cord Injury

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The effect of selective cerebral perfusion on cerebral versus somatic tissue oxygenation during aortic coarctation repair in neonates and infants

BMC Anesthesiology ◽

10.1186/s12871-021-01498-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Li Zhang ◽

Lu Liu ◽

Zhiqiu Zhong ◽

Hengfang Jin ◽

Jian Jia ◽

...

Keyword(s):

Aortic Coarctation ◽

Cerebral Perfusion ◽

Tissue Oxygenation ◽

Perioperative Complications ◽

Somatic Tissue ◽

Tissue Oxygen Saturation ◽

Selective Cerebral Perfusion ◽

Arterial Blood ◽

Coarctation Repair ◽

Neonates And Infants

Abstract Background Suboptimal tissue perfusion and oxygenation may be the root cause of certain perioperative complications in neonates and infants having complicated aortic coarctation repair. Practical, effective, and real-time monitoring of organ perfusion and/or tissue oxygenation may provide early warning of end-organ mal-perfusion. Methods Neonates/infants who were scheduled for aortic coarctation repair with cardiopulmonary bypass (CPB) and selective cerebral perfusion (SCP) from January 2015 to February 2017 in Children’s Hospital of Nanjing Medical University participated in this prospective observational study. Cerebral and somatic tissue oxygen saturation (SctO2 and SstO2) were monitored on the forehead and at the thoracolumbar paraspinal region, respectively. SctO2 and SstO2 were recorded at different time points (baseline, skin incision, CPB start, SCP start, SCP end, aortic opening, CPB end, and surgery end). SctO2 and SstO2 were correlated with mean arterial pressure (MAP) and partial pressure of arterial blood carbon dioxide (PaCO2). Results Data of 21 patients were analyzed (age=75±67 days, body weight=4.4±1.0 kg). SstO2 was significantly lower than SctO2 before aortic opening and significantly higher than SctO2 after aortic opening. SstO2 correlated with leg MAP when the measurements during SCP were (r=0.67, p<0.0001) and were not included (r=0.46, p<0.0001); in contrast, SctO2 correlated with arm MAP only when the measurements during SCP were excluded (r=0.14, p=0.08 vs. r=0.66, p<0.0001). SCP also confounded SctO2/SstO2’s correlation with PaCO2; when the measurements during SCP were excluded, SctO2 positively correlated with PaCO2 (r=0.65, p<0.0001), while SstO2 negatively correlated with PaCO2 (r=-0.53, p<0.0001). Conclusions SctO2 and SstO2 have distinct patterns of changes before and after aortic opening during neonate/infant aortic coarctation repair. SctO2/SstO2’s correlations with MAP and PaCO2 are confounded by SCP. The outcome impact of combined SctO2/SstO2 monitoring remains to be studied.

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44 DIFFERENTIAL PERISPINAL OXYGEN SATURATION DURING NEONATAL AND PEDIATRIC AORTIC COARCTATION REPAIR.

Journal of Investigative Medicine ◽

10.2310/6650.2005.x0015.122 ◽

2006 ◽

Vol 54 (2) ◽

pp. S380.5-S380

Author(s):

KA. Krajewski ◽

J. Henson ◽

H. L. Edmonds ◽

A. Sehic ◽

E. H. Austin ◽

...

Keyword(s):

Oxygen Saturation ◽

Aortic Coarctation ◽

Coarctation Repair

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Novel Application of Custom-Made Stent Grafts with Inner Branches for Secondary Treatment After Stent Graft Migration of Previous Infrarenal Endovascular Aortic Repair

Annals of Vascular Surgery ◽

10.1016/j.avsg.2019.12.015 ◽

2020 ◽

Vol 66 ◽

pp. 665.e9-665.e15

Author(s):

Mario D'Oria ◽

Filippo Griselli ◽

Davide Mastrorilli ◽

Francesco Riccitelli ◽

Filippo Gorgatti ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Aortic Repair ◽

Secondary Treatment ◽

Stent Grafts ◽

Aortic Repair ◽

Custom Made ◽

Graft Migration

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Muscle-sparing aortic coarctation repair

JTCVS Techniques ◽

10.1016/j.xjtc.2020.05.005 ◽

2020 ◽

Vol 3 ◽

pp. 249-256

Author(s):

Stephanie G. Berset ◽

Hitendu Dave ◽

Christian Balmer ◽

Anna Nowacka ◽

Raymond Pfister ◽

...

Keyword(s):

Aortic Coarctation ◽

Coarctation Repair ◽

Muscle Sparing

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P1494 Incidental finding of aortic aneurysm formation following 34 years of coarctation repair by dacron patch aortoplasty

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.918 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

E A Khalifa ◽

S Helmy ◽

S F Mohamed ◽

M Alkuwari

Keyword(s):

Aortic Aneurysm ◽

Aortic Arch ◽

Subclavian Artery ◽

Aortic Coarctation ◽

Surgical Repair ◽

Left Ventricular ◽

Coarctation Repair ◽

History Of ◽

Dacron Patch

Abstract Introduction Aneurysms are found following all types of surgical repair of aortic coarctation, especially after Dacron patch aortoplasty. We describe the finding of an aortic aneurysm in an asymptomatic 52-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 34 years earlier. Case report A 52-year male, smoker, hypertensive on medication He had previous history of surgical repair of aortic coarctation at age of 18 years . Repair was by Dacron patch aortoplasty. Since then, his regular follow up was unremarkable. Recently, he was referred for cardiac evaluation as a part of pre-employment general check-up. He was asymptomatic with no history of shortness of breath or chest pain. Physical examination revealed that the pulse in the left arm was reduced in volume in comparison to the right one. The heart sounds were essentially normal but a pericardial murmur was audible, perhaps reflecting residual collateral flow. Blood pressure was 156/83 mmHg in right arm and 142/81 in the left arm. Transthoracic echocardiography revealed mild left ventricular hypertrophy with normal global and regional contractility and an ejection fraction of 58%. Supra sternal window images showed dilatation of the three aortic arch branches. The distal portion of aortic arch just distal to origin of left subclavian artery was narrowed with a peak systolic gradient across of 34 mmHg. A cystic structure (1.7 cm x 1.9 cm) was visualized attached to the narrowed segment of the aorta, suggestive of a saccular aneurysm, (figures A&B&C). Computed tomography aortogram showed a narrow-necked aneurysm arising from the posterolateral aspect of the distal aortic arch (anticipated site of the coarctation repair graft anastomosis). A small laminated thrombus was also noted within. Aneurysm measured approximately 2.2 x 3.3 cm in its craniocaudal and anteroposterior dimensions respectively, with no evidence of aortic luminal compromise. (figures D&E&F). Management Aneurysmectomy was performed subsequently. Interposition polyester grafts were used to reconstruct the aortic arch and proximal descending aorta and to connect this aortic segment to the subclavian artery via a lateral thoracotomy. The postoperative course thereafter was uneventful. Conclusion: This is a rare insidious complication of Dacron patch aortoplasty that occurred after more than 3 decades, which highlights the importance of diagnostic imaging in the follow up of these patients Abstract P1494 Figure.

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