JCK E-Oral Presentation 1 (II-JCKEOP01)

[II-JCKEOP01-05] Surgical outcomes of open surgical repair for coarctation of the aorta in adolescent and adult in the era of endovascular therapy

^○Yoshikatsu Saiki, Osamu Adachi, Masatoshi Akiyama, Ichiro Yoshioka, Satoshi Kawatsu, Yukihiro Hayatsu,Yusuke Suzuki, Konosuke Sasaki, Kiichiro Kumagai, Shunsuke Kawamoto, (Division of Cardiovascular Surgery, Tohoku University, Sendai, Japan)

Background: Surgical repair for coarctation of the aorta (CoA) in adolescent and adult remains challenging since the lesion typically involves extensive area from the transverse arch to the proximal descending thoracic aorta. Although endovascular therapy has been evolving, contemporary surgical outcome has yet to be definitively determined. Purpose: We sought to evaluate our short and mid-tem outcomes after repair of adult CoA. Patients and methods: Between 2001 and 2016, 10 patients (mean 37.2 ys, range, 17-64 ys) underwent reparative procedures for CoA. Of those, primary CoA was diagnosed in 6 patients, Re-CoA in 2 and aortic aneurysm after previous patch aortoplasty in 2. Only one patient underwent TEVAR. The remaining 9 patients underwent open surgery. Left thoracotomy approach was employed when proximal aortic clamp was placed between the left carotid and subclavian arteries, whereas median sternotomy ± anterolateral thoracotomy with selective cerebral perfusion (SCP) were employed to perform total or partial aortic arch replacement. Results: Nine patients were associated with aneurysmal changes in the aorta. For those who underwent SCP (n=7), mean SCP time was 151.6 min (27-422 min). There were no hospital mortality, stroke or spinal cord injury. No aortic event or cerebrovascular complications were encountered during long-term follow-up. Conclusions: CoAs in adolescent and adult were frequently associated with aortic aneurysm necessitating the use of SCP; thus, require invasive surgery. However, the short and mid-tem outcomes are favorable and durable.