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Ann Thorac Surg 1999;67:1386-1390
© 1999 The Society of Thoracic Surgeons

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Original Articles

Operation for mid-arch coarctation

^a Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, Oxford, England, UK

Accepted for publication December 7, 1998.

Address reprint requests to Dr Katsumata, Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, England
e-mail: katsu{at}AHF.org.uk

Background. Coarctation occurring within the aortic arch is rare and may present difficulties during surgical repair. We describe the operative technique and outcome in 6 patients with this unusual anomaly.

Methods. Five patients had antegrade perfusion with circulatory arrest. Three patients with presubclavian narrowing (one presenting with type B dissection) were operated through extended left thoracotomy. Two precarotid and paracarotid lesions were approached through a median sternotomy. All patients were perfused antegradely from the ascending aorta and operated with hypothermic circulatory arrest. One patient who had a complex presubclavian coarctation after two previous repairs received an ascending aorta to abdominal aorta bypass graft without cardiopulmonary bypass.

Results. All patients survived operation and are well at a mean follow-up of 3.3 years after the procedure. None had cerebral problems or spinal cord injury. Renal function was unchanged. The mean (± standard error of the mean) resting gradient across the coarctation decreased from 42 ± 4.0 mm Hg to 6 ± 1.2 mm Hg (p = 0.0004).

Conclusions. Hypothermic circulatory arrest using antegrade ascending aortic perfusion allows safe and effective repair of mid-arch coarctation. Complicated reoperations can be managed safely using ascending-to-abdominal aortic bypass.

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