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Eur J Cardiothorac Surg 2001;20:1199-1201
© 2001 Elsevier Science NL

The use of left heart bypass in adult and recurrent coarctation repair

Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK

Received 22 May 2001; accepted 31 August 2001.

Corresponding author. Tel.: +44-7050-609-664; fax: +44-870-126-9996
e-mail: wongch{at}postmaster.co.uk

Objectives: Paraplegia following coarctation repair occurs in 0.4% of infants. However, for older children, adults and re-operations, the incidence can be as high as 2.6%. Yet there is no consensus on the need for spinal cord protection or the optimal method. This paper reports our experience with left heart bypass (LHB) in adult and re-do coarctation. Methods: Between 1997 and 2000, nine patients underwent elective resection of coarctation (three re-dos, two balloons) with a mean age of 17.9 years (range, 8–44) and weight of 52 kg (range, 17.3–109). The mean trans-coarctation gradient was 29.6 mmHg (range, 20–45). Patients were placed on LHB using a centrifugal pump with full heparinization through a fourth-space thoracotomy. Patients were cooled to 31–34°C for additional spinal cord protection. Repair was carried out with an inter-positional graft (5/9), a Gore-Tex patch (2/9) or end-to-end anastomosis (2/9). The mean cross-clamp and bypass times were 36.4 (range, 19–65) and 40.3 min (range, 22–70), respectively. Results: No patient developed transient or permanent paraplegia. The mean peak creatinine was 80 µmol/l (range, 51–123). Conclusions: LHB is simple, easy and safe to implement, and is the only technique capable of maintaining independent upper and lower body perfusion pressure. Potentially, it provides the best spinal cord protection, and extends the margin of safety and time to execute an accurate repair.

Key Words: Left heart bypass • Coarctation • Paraplegia

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