Objective To summarize the experiences of the surgical management for adult patients with aortic coarctation. Methods Clinical data of 40 adult patients diagnosed with aortic coarctation undergoing surgical repair in our center between July 2004 and March 2015 were retrospectively analyzed. There were 28 males and 15 females with a mean age of 26.3±11.0 years (ranging 16-57 years). We evaluated the effect of surgery by the change of pressure gradient between upper limb and lower limb, mechanical ventilation time, and length of ICU stay and hospital stay. Results Forty surgeries were finished successfully. One patient died after surgery. The follow-up ranged from 12 to 36 months. The mean pressure gradient reduced significantly after surgery. There were 6 patients suffering blood hypertension at their discharge, and all of them still need antihypertensive drugs. Conclusion Surgical repair is an effective treatment for adult with aortic coarctation. Extra-anatomic ascending-to-descending aortic bypass and concomitant repair of intracardiac anomalies is safe and effective.
The surgical treatment of acute aortic dissection is difficult, and the mortality is associated with anastomosis site complications. Therefore, it is essential to make sure the end-to-end anastomosis safe and avoid bleeding. The methods of anastomosis include: direct anastomosis, adventitial inversion technique and sandwich technique. The latter two methods are both effective in hemostasis and reducing the postoperative complications. According to the recent literatures, the adventitial inversion technique may facilitate thrombotic closure of the false lumen in acute type A aortic dissection management and increase the long-term survival of the patients. This review introduces 2 modified methods of anastomosis as well, and summarizes clinical outcomes of different end-to-end anastomotic methods for surgical treatment of acute Stanford type A aortic dissection, in order to recommend the most proper method of end-to-end anastomosis.