Single-Stage Repair of Thoracic Aortic Aneurysm through a Median Sternotomy in a Patient with Pseudocoarctation of the Aorta and Severe Aortic Valve Stenosis

Distal arch replacement for aortic aneurysm associated with pseudocoarctation through the L-incision approach

We report the case of a 16-year-old boy in whom we successfully repaired a distal aortic arch aneurysm associated with pseudocoarctation using double aortic cannulation and antegrade selective cerebral perfusion through the L-incision approach. This approach provided excellent exposure from the ascending aorta to the descending aorta, which enabled total body perfusion. We avoided cardiac arrest and hypothermic circulatory arrest during the surgery. The L-incision approach could be a better alternative for aortic arch surgery in adolescents.

A Pseudocoarctation of the Aorta With a Left Subclavian Artery Aneurysm, A Case Report and A Review of the Literature

Here we present a 47-year-old male diagnosed with a pseudocoarctation of the aorta and a funnel-like subclavian artery aneurysm with a large orifice and severe aortic valve insufficiency. The patient underwent a two-stage repair for both pathologies. After an aortic valve replacement, postcardiotomy pericardial effusion occurred and was medically managed. Six months later, the patient underwent a distal arcus aorta and subclavian artery replacement with a left posterolateral thoracotomy as the second stage. Due to the strict adhesions, pulmonary veins were not cannulated and an extracorporeal bypass between the pulmonary artery and femoral artery was used for distal body perfusion. The coincidence of subclavian aneurysms and a pseudocoarctation of the aorta is rare and a literature review was performed to identify treatment options for this pathology.

Bicuspid aortic valve with critical coarctation of the aorta: single- or two-stage operation?

Background

A bicuspid aortic valve (BAV) with critical coarctation of the aorta (CoA) is a rare but dangerous congenital cardiac malformation. The aim of this study was to compare the benefits of a single- versus two-stage operation for patients of BAV with CoA.

Methods

We retrospectively evaluated 20 patients of BAV and CoA who underwent surgery from 2000 to 2016 in our center. Eight patients underwent a single-stage procedure through a median sternotomy approach, while 12 patients underwent two-stage operation.

Results

The patients' baseline characteristics were similar between the two groups, and the overall mortality rate was 0%. No significant differences were found in the postoperative pressure gradient (P=0.64), use of implants (P=0.81), reoperation for bleeding, phrenic nerve injury, blood transfusion (P=1.00), or thromboembolic events between the two groups. However, patients in the single-stage group sustained less surgical trauma and ICU stay hours (P<0.01) than those in the two-stage group.

Conclusions

Performance of a single-stage operation was feasible for patients of BAV with CoA. It was a safe and optimal choice with less surgical trauma compared with a two-stage operation.