Key result
Bilateral aortofemoral bypass was a safe and effective alternative to the hybrid procedure for one-staged treatment of complicated aortic coarctation, with similar rates of follow-up positive events.
Why the study?
One-staged surgical treatment of aortic coarctation combined with cardiac anomalies is challenging, prompting evaluation of the feasibility of bilateral aortofemoral bypass compared with catheter intervention plus stent.
Does one-staged bilateral aortofemoral bypass yield comparable surgical and hemodynamic outcomes to a hybrid procedure in patients with aortic coarctation complicated by cardiac anomalies?
Cohort (n=50)
No
Does one-staged bilateral aortofemoral bypass yield comparable surgical and hemodynamic outcomes to a hybrid procedure in patients with aortic coarctation complicated by cardiac anomalies?
Bilateral aortofemoral bypass is a safe and effective alternative to the hybrid method for one-staged surgical treatment of aortic coarctation complicated by cardiac anomalies, yielding comparable reductions in peak systolic gradient.
Answers are grounded in this paper and cite their sources.
Comparable gradient reductions support bilateral bypass as alternative in observational data; leaves open need for randomized confirmation in complex coarctation.
Objective: One-staged surgical treatment of aortic coarctation combined with cardiac anomalies is challenging. We aim to evaluate the feasibility of bilateral aortofemoral bypass technique in one-staged surgery treating coractation by comparing surgical outcomes with catheter intervention plus stent(hybrid).Methods: Between January 2012 and December 2017, 50 patients underwent one-staged surgical procedures to treat coarctation and repair concomitant cardiac anomalies, like aortic root dilatation, cardiac valvular disease and so on. Among them, 30 patients underwent bilateral aortofemoral bypass and 20 patients underwent hybrid procedure to treat coarctation. We retrospectively analyzed the data of these patients and compared the early and late results. Results: All the baseline clinical characteristics were comparable between groups except that the mean age of bypass group was 39.5±14.0 years which was older than hybrid group (27.9±8.5 years, P=0.002). Technical success was achieved in all patients, with no hospital death or other severe complications. Immediately after surgery, in bypass and hybrid group, the mean upper-limb systolic blood pressure decreased from 159.4mmHg to 119.7mmHg and 148.4mmHg to 111.6mmHg, the median peak systolic gradient decreased from 68.0mmHg to 10mmHg and 46.5mmHg to 10mmHg respectively(P=0.09). And the mean upper-lower limbs gradient decreased from 21.7mmHg to 5.9mmHg and 21.0mmHg to 2.7mmHg respectively(P=0.104). The mean follow-up time was 76.92±18.7 in bypass group and 85.4±20.6 months in hybrid group. There were 4 late deaths in bypass group (one died of gastrointestinal bleeding, one died of pulmonary embolism and the other two died of heart failure caused by mechanical prosthetic valve dysfunction). The follow-up peak systolic gradient and other blood pressure parameters showed stable and no differences between two groups.Conclusions: The bilateral aortofemoral bypass surgery is a safe and effective method which can be used in one-staged surgical strategy to treat coarctation complicated by cardiac anomalies and can be an alternative to the hybrid method.
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Lin et al. (2022) conducted a cohort in Aortic coarctation complicated by cardiac anomalies (n=50). Bilateral aortofemoral bypass vs. Hybrid procedure (catheter intervention plus stent) was evaluated on Positive event (PSG > 20mmHg or severe stenosis of the graft/stent) during follow-up (p=1). Bilateral aortofemoral bypass was a safe and effective alternative to the hybrid procedure for one-staged treatment of complicated aortic coarctation, with similar rates of follow-up positive events.
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