Selective Use of Left Heart Bypass for Aortic Coarctation

Andrew C. Fiore, Mark Ruzmetov, Robert G. Johnson, Mark Rodefeld, Karen Rieger, Mark Turrentine, John Brown

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: We evaluated left heart bypass (LHB) for spinal cord protection during aortic coarctation repair in patients with mild (primary, postsurgical, or intervention) and complex coarctation. Methods: Between 1990 and 2008, 19 patients (mean age, 21 years; weight, 70 ± 16 kg) using LHB were compared with 27 patients (mean age, 16 years; weight, 65 ± 8 kg) undergoing coarctation repair without LHB (non-LHB). Follow-up was similar (LHB, 5 ± 4 vs non-LHB 4 ± 3 years; p = 0.81). Results: Cohorts were similar in age and body surface area. No non-LHB patient lost somatosensory evoked potential or had a femoral artery pressure below 45 mm Hg with test clamping. LHB more often allowed graft interposition (18 of 19 [95%] vs non-LHB, 7 of 27 [26%]; p < 0.003) and a longer clamp time (LHB 44 ± 16 vs non-LHB 31 ± 12 minutes p < 0.003) without spinal cord ischemia. Two non-LHB patients had temporary spinal cord paresis. No early or late deaths occurred. Reintervention (LHB, 2 of 19 [11%] vs non-LHB, 2 of 27 [7%]; p = 0.82) and antihypertensive requirements were similar (LHB, 9 of 19 [40%] vs non-LHB, 8 of 27 [30%]; p = 0.35). The late peak transcoarctation gradient was 8 ± 6 mm Hg in the LBH cohort vs 18 ± 11 mm Hg in non-LBH patients (p= 0.001). Conclusions: Although the adequacy of spinal cord collateral assessment in coarctation repair is imperfect, no spinal cord ischemia occurred with coarctation repair and LHB. We recommend LHB in patients with mild or complex coarctation.

Original languageEnglish
Pages (from-to)851-857
Number of pages7
JournalAnnals of Thoracic Surgery
Volume89
Issue number3
DOIs
StatePublished - Mar 2010

Fingerprint

Left Heart Bypass
Aortic Coarctation
Spinal Cord Ischemia
Spinal Cord
Weights and Measures
Somatosensory Evoked Potentials
Body Surface Area
Paresis
Femoral Artery
Constriction
Antihypertensive Agents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Selective Use of Left Heart Bypass for Aortic Coarctation. / Fiore, Andrew C.; Ruzmetov, Mark; Johnson, Robert G.; Rodefeld, Mark; Rieger, Karen; Turrentine, Mark; Brown, John.

In: Annals of Thoracic Surgery, Vol. 89, No. 3, 03.2010, p. 851-857.

Research output: Contribution to journalArticle

Fiore, Andrew C. ; Ruzmetov, Mark ; Johnson, Robert G. ; Rodefeld, Mark ; Rieger, Karen ; Turrentine, Mark ; Brown, John. / Selective Use of Left Heart Bypass for Aortic Coarctation. In: Annals of Thoracic Surgery. 2010 ; Vol. 89, No. 3. pp. 851-857.
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abstract = "Background: We evaluated left heart bypass (LHB) for spinal cord protection during aortic coarctation repair in patients with mild (primary, postsurgical, or intervention) and complex coarctation. Methods: Between 1990 and 2008, 19 patients (mean age, 21 years; weight, 70 ± 16 kg) using LHB were compared with 27 patients (mean age, 16 years; weight, 65 ± 8 kg) undergoing coarctation repair without LHB (non-LHB). Follow-up was similar (LHB, 5 ± 4 vs non-LHB 4 ± 3 years; p = 0.81). Results: Cohorts were similar in age and body surface area. No non-LHB patient lost somatosensory evoked potential or had a femoral artery pressure below 45 mm Hg with test clamping. LHB more often allowed graft interposition (18 of 19 [95{\%}] vs non-LHB, 7 of 27 [26{\%}]; p < 0.003) and a longer clamp time (LHB 44 ± 16 vs non-LHB 31 ± 12 minutes p < 0.003) without spinal cord ischemia. Two non-LHB patients had temporary spinal cord paresis. No early or late deaths occurred. Reintervention (LHB, 2 of 19 [11{\%}] vs non-LHB, 2 of 27 [7{\%}]; p = 0.82) and antihypertensive requirements were similar (LHB, 9 of 19 [40{\%}] vs non-LHB, 8 of 27 [30{\%}]; p = 0.35). The late peak transcoarctation gradient was 8 ± 6 mm Hg in the LBH cohort vs 18 ± 11 mm Hg in non-LBH patients (p= 0.001). Conclusions: Although the adequacy of spinal cord collateral assessment in coarctation repair is imperfect, no spinal cord ischemia occurred with coarctation repair and LHB. We recommend LHB in patients with mild or complex coarctation.",
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N2 - Background: We evaluated left heart bypass (LHB) for spinal cord protection during aortic coarctation repair in patients with mild (primary, postsurgical, or intervention) and complex coarctation. Methods: Between 1990 and 2008, 19 patients (mean age, 21 years; weight, 70 ± 16 kg) using LHB were compared with 27 patients (mean age, 16 years; weight, 65 ± 8 kg) undergoing coarctation repair without LHB (non-LHB). Follow-up was similar (LHB, 5 ± 4 vs non-LHB 4 ± 3 years; p = 0.81). Results: Cohorts were similar in age and body surface area. No non-LHB patient lost somatosensory evoked potential or had a femoral artery pressure below 45 mm Hg with test clamping. LHB more often allowed graft interposition (18 of 19 [95%] vs non-LHB, 7 of 27 [26%]; p < 0.003) and a longer clamp time (LHB 44 ± 16 vs non-LHB 31 ± 12 minutes p < 0.003) without spinal cord ischemia. Two non-LHB patients had temporary spinal cord paresis. No early or late deaths occurred. Reintervention (LHB, 2 of 19 [11%] vs non-LHB, 2 of 27 [7%]; p = 0.82) and antihypertensive requirements were similar (LHB, 9 of 19 [40%] vs non-LHB, 8 of 27 [30%]; p = 0.35). The late peak transcoarctation gradient was 8 ± 6 mm Hg in the LBH cohort vs 18 ± 11 mm Hg in non-LBH patients (p= 0.001). Conclusions: Although the adequacy of spinal cord collateral assessment in coarctation repair is imperfect, no spinal cord ischemia occurred with coarctation repair and LHB. We recommend LHB in patients with mild or complex coarctation.

AB - Background: We evaluated left heart bypass (LHB) for spinal cord protection during aortic coarctation repair in patients with mild (primary, postsurgical, or intervention) and complex coarctation. Methods: Between 1990 and 2008, 19 patients (mean age, 21 years; weight, 70 ± 16 kg) using LHB were compared with 27 patients (mean age, 16 years; weight, 65 ± 8 kg) undergoing coarctation repair without LHB (non-LHB). Follow-up was similar (LHB, 5 ± 4 vs non-LHB 4 ± 3 years; p = 0.81). Results: Cohorts were similar in age and body surface area. No non-LHB patient lost somatosensory evoked potential or had a femoral artery pressure below 45 mm Hg with test clamping. LHB more often allowed graft interposition (18 of 19 [95%] vs non-LHB, 7 of 27 [26%]; p < 0.003) and a longer clamp time (LHB 44 ± 16 vs non-LHB 31 ± 12 minutes p < 0.003) without spinal cord ischemia. Two non-LHB patients had temporary spinal cord paresis. No early or late deaths occurred. Reintervention (LHB, 2 of 19 [11%] vs non-LHB, 2 of 27 [7%]; p = 0.82) and antihypertensive requirements were similar (LHB, 9 of 19 [40%] vs non-LHB, 8 of 27 [30%]; p = 0.35). The late peak transcoarctation gradient was 8 ± 6 mm Hg in the LBH cohort vs 18 ± 11 mm Hg in non-LBH patients (p= 0.001). Conclusions: Although the adequacy of spinal cord collateral assessment in coarctation repair is imperfect, no spinal cord ischemia occurred with coarctation repair and LHB. We recommend LHB in patients with mild or complex coarctation.

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