Document Detail

Selective use of left heart bypass for aortic coarctation.
MedLine Citation:
PMID:  20172142     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We evaluated left heart bypass (LHB) for spinal cord protection during aortic coarctation repair in patients with mild (primary, postsurgical, or intervention) and complex coarctation. METHODS: Between 1990 and 2008, 19 patients (mean age, 21 years; weight, 70 +/- 16 kg) using LHB were compared with 27 patients (mean age, 16 years; weight, 65 +/- 8 kg) undergoing coarctation repair without LHB (non-LHB). Follow-up was similar (LHB, 5 +/- 4 vs non-LHB 4 +/- 3 years; p = 0.81). RESULTS: Cohorts were similar in age and body surface area. No non-LHB patient lost somatosensory evoked potential or had a femoral artery pressure below 45 mm Hg with test clamping. LHB more often allowed graft interposition (18 of 19 [95%] vs non-LHB, 7 of 27 [26%]; p < 0.003) and a longer clamp time (LHB 44 +/- 16 vs non-LHB 31 +/- 12 minutes p < 0.003) without spinal cord ischemia. Two non-LHB patients had temporary spinal cord paresis. No early or late deaths occurred. Reintervention (LHB, 2 of 19 [11%] vs non-LHB, 2 of 27 [7%]; p = 0.82) and antihypertensive requirements were similar (LHB, 9 of 19 [40%] vs non-LHB, 8 of 27 [30%]; p = 0.35). The late peak transcoarctation gradient was 8 +/- 6 mm Hg in the LBH cohort vs 18 +/- 11 mm Hg in non-LBH patients (p= 0.001). CONCLUSIONS: Although the adequacy of spinal cord collateral assessment in coarctation repair is imperfect, no spinal cord ischemia occurred with coarctation repair and LHB. We recommend LHB in patients with mild or complex coarctation.
Andrew C Fiore; Mark Ruzmetov; Robert G Johnson; Mark D Rodefeld; Karen Rieger; Mark W Turrentine; John W Brown
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2010-03-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  851-6; discussion 856-7     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Section of Cardiothoracic Surgery, St. Louis University School of Medicine, St. Louis, Missouri 63104, USA.
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MeSH Terms
Aortic Coarctation / surgery*
Collateral Circulation
Heart Bypass, Left* / adverse effects
Ischemia / etiology,  prevention & control
Spinal Cord / blood supply
Young Adult

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