Simultaneously surgical management of adult complex coarctation of aorta concomitant with intracardiac abnormality

Background: To explore surgical management of complex coarctation of aorta (COA) concomitant with intracardiac abnormality, in order to provide recommendations for safe and reliable treatment. Methods: Totally, six adult cases demonstrating complex COA concomitant with intracardiac abnormality were reviewed from our department between May 2012 and June 2017. Four patients were male and two patients were female, the age range being 43.8 +/- 10.6 years old. The associated intracardiac abnormality included 3 aortic root aneurysms, 3 aortic insufficiency, 1 aortic stenosis, 3 mitral regurgitation (MR), 1 coronary artery disease (CAD), 1 patent ductus arteriosus (PDA) and 1 ventricular septal defect (VSD). All patients received extra-anatomic aortic bypass approach to tackle complex COA. The extra-anatomic aortic bypasses comprised 4 ascending-descending aortic bypass grafting and 2 ascending-abdominal aortic bypass grafting. Simultaneous intracardiac abnormality repair procedures comprised 3 Bentall procedures, 1 aortic valve replacement, 3 mitral valve repairs, 1 coronary artery bypass grafting, 1 PDA repair and 1 VSD repair. Results: There was no early or late mortality. None of the patients suffered from stroke or paraplegia. Only 1 patient received reexploration for hemostasis because of post-pericardial anastomosis bleeding. The same patient suffered from acute renal failure, but completely recovered after 7-day hemodialysis. All other patients had uneventful post-operative recoveries. The follow-up (mean 37 +/- 22.9 months) showed that all patients survived and all patients' blood pressures significantly decreased (pre-operative 165.8 +/- 16.3mmHg versus post-operative 121.5 +/- 10.8 mmHg, P<0.05). All patients have significantly reduced ankle-brachial pressure gradients (pre-operative 63.3 +/- 17.2 mmHg versus post-operative 29.1 +/- 4.3 mmHg, P<0.05). All aortic grafts maintained patent flow. Conclusions: Simultaneous management of complex COA concomitant with intracardiac abnormality is a safe and reliable surgical method.