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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: Stany.Sandrio@med.uni-heidelberg.de; s.p.sandrio@googlemail.com
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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 

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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

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