Strategy of Surgical Correction of Postcoarctation Thoracic Aortic Aneurysms

Vitalii I. Kravchenko; Yurii M. Tarasenko; Alla V. Derkach; Ivan M. Kravchenko

doi:10.30702/ujcvs/23.31(04)/KT007-6973

Vitalii I. Kravchenko National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-4873-5367
Yurii M. Tarasenko National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-6814-3145
Alla V. Derkach National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0009-0004-6369-9338
Ivan M. Kravchenko National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0003-0343-8094

DOI: https://doi.org/10.30702/ujcvs/23.31(04)/KT007-6973

Keywords: coarctation of the aorta, hybrid techniques, endovascular techniques, descending thoracic aorta, aneurysm formation, TEVAR

Abstract

The aim. To analyze the experience of surgical treatment of postcoarctation aneurysms and to propose an optimal strategy in choosing a correction method.

Materials and methods. An analysis of 91 cases of postcoarctation aneurysm over a 25-year period was carried out. Eighty-five people (93.4%) were operated on, 6 patients (6.6%) were not operated on for various reasons. The patients were divided into clinical groups depending on the method: group I included 69 patients (75.8%) who underwent open correction of postcoarctation aneurysm. Group II consisted of 16 patients (17.6%) after endovascular or hybrid treatment.

Results. The obtained results demonstrated significant achievements and pronounced clinical effect of the performed surgical correction of postcoarctation aneurysms. We identified indications and contraindications for the correction of postcoarctation aneurysms by various methods: open, endovascular, and hybrid. It was found that the advantages of the endovascular technique are: minimally invasive approach, absence of a large surgical wound, shorter duration of the operation, faster activation of the patient after the intervention, shorter length of hospital stay in the postoperative period, faster return to a full active life. When studying the long-term results, based on the SF-36 questionnaire scores, it was established that the quality of life was higher among patients who underwent endovascular and hybrid correction of postcoarctation aneurysms.

Conclusion. Clear indications for surgical correction of postcoarctation aneurysm and the choice between open surgery, endovascular or hybrid intervention should be determined based on detailed analysis and with the participation of the entire heart team with mandatory consideration of: patient age, comorbidities, expected duration and quality of life of each patient after surgery.

References

Hoffman JI. The challenge in diagnosing coarctation of the aorta. Cardiovasc J Afr. 2018;29(4):252-255. https://doi.org/10.5830/CVJA-2017-053
Truba I, Lukianova I, Medvedenko G, Lazoryshynets V. The Features of Pregnancy, Early Neonatal Period and Tactics of Surgical Treatment in Newborn with Hypoplastic Aortic Arch (First-Hand Experience). Ukrainskyi Zhurnal Sertsevo-sudynnoi Khirurhii. 2020;(1):37-43. Ukrainian. https://doi.org/10.30702/ujcvs/20.3803/009037-043
Beckmann E, Jassar AS. Coarctation repair–redo challenges in the adults: what to do? J Vis Surg. 2018;4:76. https://doi.org/10.21037/jovs.2018.04.07
Agasthi P, Pujari SH, Tseng A, Graziano JN, Marcotte F, Majdalany D, et al. Management of adults with coarctation of aorta. World J Cardiol. 2020;12(5):167-191. https://doi.org/10.4330/wjc.v12.i5.167
Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, et al.; Japanese Circulation Society, the Japanese Society for Cardiovascular Surgery, the Japanese Association for Thoracic Surgery and the Japanese Society for Vascular Surgery Joint Working Group. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J. 2023;87(10):1410-1621. https://doi.org/10.1253/circj.CJ-22-0794
Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, et al. Editorʼs Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017;53(1):4-52. https://doi.org/10.1016/j.ejvs.2016.06.005
Melissano G, Canaud L, Pacini D, Bilman V, Erben Y, Oo AY, et al.; International Rare Aortic Conditions (IRAC) Consortium. Surgical and endovascular treatment of late postcoarctation repair aortic aneurysms: Results from an international multicenter study. J Vasc Surg. 2022;76(6):1449-1457.e4. https://doi.org/10.1016/j.jvs.2022.04.046
Jata B, Jahollari A, Kojqiqi A, Huti G. Coarctation of Aorta and Post-Stenotic Dissecting Aortic Aneurysm Successfully Treated with Endovascular Stent. Int Med Case Rep J. 2020;13:367-370. https://doi.org/10.2147/imcrj.s267692
Saedi S, Aliramezany M, Moosavi J, Saedi T. Successful thoracic endovascular aortic repair for post-coarctoplasty aneurysm. Egypt Heart J. 2020 Mar 30;72(1):13. https://doi.org/10.1186/s43044-020-00051-7
Tabry I, Rush M. Therapeutic Alternatives in the Management of Late Complications of Surgery for Isolated Coarctation of the Aorta. Aorta (Stamford). 2018;6(2):59-64. https://doi.org/10.1055/s-0038-1669435
Brandi AC, Dos Santos CA, Brandi JM, Dos Santos MA, Botelho PHH. Long-term outcomes after endovascular aortic treatment in patients with thoracic aortic diseases. J Vasc Bras. 2023 Nov 20;22:e20220156. https://doi.org/10.1590/1677-5449.202201562

Strategy of Surgical Correction of Postcoarctation Thoracic Aortic Aneurysms

Abstract

References

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