Postcoarctation Aotrtic Aneurysms: Treatment Methods and Outcomes

Abstract

Background. Over the years of aortic coarctation (AC) repair, there have been significant changes in the development of the methods of surgical repair of this anomaly, and late complications at the site of intervention have been revealed which became even more threatening than coarctation itself.

The aim. Further planning of timely diagnosis and repair of late aneurysms in the site of AC plasty.

Material and methods. In our institution, 4252 patients with native AC were operated from 1971 to 2017. Selection of the patients with descending aorta aneurysm for this work has been limited by the year 1995. In total, 91 cases were included in the work. Eighty five (93.4 %) patients were reoperated, 6 (6.6 %) patients were not operated for various reasons. The interval between the AC repair and diagnosis of descending aorta aneurysm was 22.0 years with varia-tions from 1 month to 45 years. The frequency of descending aorta aneurysm complications after AC repair was somewhat different for individual surgical approaches. So until the present time, the descending aorta aneurysm of was detected in 61 (88.5 %) patients after synthetic patch implantation, in 6 patients (8.7 %) after the tubular prosthesis implantation and in 2 (2.8 %) patients after end-to-end anastomosis.

Results. Definite clinical pattern, which is practically unrelated to the state of the cardiovascular system, is typical for the complication of descending aorta aneurysm. Clinical research is carried out according to the usual plan, until the mo-ment the patient undergoes chest X-ray. CT angiography makes the most sense, as it provides detailed reproduction of the descending aorta aneurysm anatomy.

In each case of the descending aorta aneurysm found, the patient was offered a repeated surgical intervention for the purpose of aneurysm resection or its removal from the blood flow. These operations required high-quality anaesthetic and surgical care. Even before the full mobilization of aorta and aneurysm, a temporary bypass shunt (TBSH) was set up (75.3 % of cases), or a CPB pump was used (24.7 % of cases).

Over a long time the best method of repeated interventions in postcoarctation descending aorta aneurysms was resection of descending aorta aneurysm followed by implantation of the vascular prosthesis. Since 2014, our institution began to use endovascular (5 [5.8 %] cases) and hybrid methods for the treatment of postcoarctation aortic aneurysms (11 [12.9 %]).

Reoperations conducted with resection of descending aorta aneurysm and prosthetics of aorta were performed in 69 patients. Of these, 7 patients were operated twice, and 2 patients were operated three times.

Eighty (94.1 %) patients underwent reoperation satisfactorily and were discharged from the hospital. Five patients (5.9%) died with severe destructive changes in the blood vessels and lungs, most of them during the development of re-interventions.

Conclusion. Late complications (aneurysm) occur with a frequency of 4.5 %. Operation tactics should be chosen taking into account the type of primary reconstructive surgery, present complications and features found during the research. The patients undergoing repeated reconstructive operations regarding the repair of post coarctation aneurysms require lifetime follow-up monitoring.