Long Term Outcomes for Surgery Site Aneurysm

Coarctation-associated aneurysms: a localized disease or diffuse aortopathy.

Authors

Preventza O¹, Livesay JJ, Cooley DA, Krajcer Z, Cheong BY, Coselli JS.

Author information

Journal

Ann Thorac Surg. 2013 Jun;95(6):1961-7; discussion 1967. doi: 10.1016/j.athoracsur.2013.03.062. Epub 2013 May 2.

Affiliation

Abstract

BACKGROUND: We evaluated the occurrence and treatment of aortic aneurysms in coarctation patients.

METHODS: During 1962 to 2011, 943 cases of coarctation were repaired. Aortic aneurysms were identified in 55 patients (5.8%). Forty-eight had prior coarctation repair (median 23 years earlier, interquartile range 18 to 26 years). Forty-two aneurysms were found in the descending thoracic aorta (76.4%), 18 in the ascending aorta (32.7%), 8 in the left subclavian artery (14.5%), and 1 each (1.8%) in the abdominal aorta, iliac artery, and innominate artery. Twenty-three patients (41.8%) had multiple aneurysms. Twenty-five patients (45.4%) had a bicuspid aortic valve.

RESULTS: Fifty-three patients’ aneurysms were treated surgically. Thirty-five (66.0%) had descending thoracic aortic repair, of whom 11 had aorto-left subclavian bypass. Aortic cross-clamping alone was used in 23 patients, left heart bypass in 4, and circulatory arrest in 8. Eleven patients underwent endovascular repair (20.8%). Proximal aortic aneurysms were repaired in 7 patients (13.2%); 1 had simultaneous antegrade endostent delivery. Four patients had ascending-to-descending aortic bypass (7.3%). Concomitant valve-sparing root repair was performed in 2 patients, Bentall in 4, aortic valve replacement in 3, and coronary artery bypass in 1. One 30-day death occurred (1.9%). Three patients (5.7%) had transient neurologic deficits, 2 (3.8%) required tracheostomy, and 11 (20.8%) had vocal cord paralysis.

CONCLUSIONS: Coarctation is a marker for aortic aneurysm formation in adults and merits long-term surveillance. Anatomic complexity and associated conditions can complicate the surgical repair. Various open, extra-anatomic, and endovascular techniques may be used.

PMID 23643549 [PubMed – indexed for MEDLINE]

Elsevier Science: Full text

Vasa. 2010 Feb;39(1):3-16. doi: 10.1024/0301-1526/a000001.

Aortic aneurysms after correction of aortic coarctation: a systematic review.

von Kodolitsch Y1, Aydin AM, Bernhardt AM, Habermann C, Treede H, Reichenspurner H, Meinertz T, Dodge-Khatami A.

Author information

1University Heart Center, Hamburg, Germany. kodolitsch@uke.de

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Abstract

Despite advanced techniques for surgical or percutaneous therapy coarctation of the aorta continues to carry a high risk of aneurysmal formation. Mortality of these aneurysms ranges between <1 and >90%, reflecting remarkable differences in surgical strategies and the follow-up management of coarctation. We review the frequency, anatomical types, risk factors and mechanisms of aortic aneurysm forming late after surgical or percutaneous therapy of aortic coarctation. We emphasize that aneurysms do not form exclusively at the site of previous intervention, but also at remote locations such as the ascending aorta. Moreover, aneurysm formation may only in part be attributed to a specific technique of coarctation therapy, and we emphasize the role of a bicuspid aortic valve and inherent weakness of the aortic wall as significant risk factors for aneurysm after aortic coarctation. We report the presenting symptoms, follow-up protocols, and imaging criteria for local and proximal aneurysms. Finally, we discuss criteria for prophylactic intervention at the site of such aneurysms, and present therapeutic options for different types of aneurysms. With this systematic review, we wish to provide data for establishing more uniform strategies for preventing, diagnosing and treating aneurysms associated with aortic coarctation.