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Evolving treatment strategies for aortic coarctation and late complications in teens and adults

Evolving treatment strategies for aortic coarctation and late complications in teens and adults. Eric E. Roselli, MD, Akshat C. Pujara, BA, Lars G. Svensson, MD,PhD, Roy K. Greenberg, MD, Larry Latson, MD. Late Coarctation. Growing population More survivors of early repair

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Evolving treatment strategies for aortic coarctation and late complications in teens and adults

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  1. Evolving treatment strategies for aortic coarctation and late complications in teens and adults Eric E. Roselli, MD, Akshat C. Pujara, BA, Lars G. Svensson, MD,PhD, Roy K. Greenberg, MD, Larry Latson, MD

  2. Late Coarctation Growing population More survivors of early repair Improved imaging and awareness New treatment modalities Endovascular, hybrid options Patient specific approach Anatomic variations and concomitant disease Bryant et al, J Card Surg, 2008; Kutty et al, Ann Thorac Surg, 2008

  3. Objective Review open, hybrid, and endovascular treatment strategies and their indications for patients with late aortic coarctation or post-coarctation repair complications

  4. Patients January 2000 to April 2009 n = 95 Aortic Coarctation Post-Repair Complications Mean Age 44 years (range 13 – 71)

  5. Repair Strategies 50 Zero Mortality n 12 12 9 5 4 3 Inter- position Graft Clamshell Repair Extra-Anatomic Bypass ET with Endo Completion Frozen ET Stent- Grafts Stents

  6. Varied Indications, Multiple Approaches Post-Repair Aneurysm Newly Diagnosed Coarctation n = 18 5 approaches n = 35 5 approaches n = 40 4 approaches n = 2 Recurrent Coarctation Long Segment Coarctation

  7. Conventional Open Repair Interposition Graft Clamshell Approach Abnormal Arch Reoperation Concomitant AVR Ascending Other Normal Arch New Dg Healthy Pt Poor Compliance Durable, Proven

  8. Extra-Anatomic Bypass Concomitant valve repair Severe COPD Long segment dz Failed Stenting

  9. ET with Endovascular Completion Post-coarct Aneurysm Concomitant valve And Hypo-arch Multiple Reoperation

  10. Frozen Elephant Trunk Post-coarct Aneurysm Hypo-arch

  11. Endovascular Bare Stent Stentgraft Branched Recurrent coarct New Dg Post-coarct Aneurysm Normal Arch

  12. Late Coarctation and Post-repair Complications Indications and presentation are diverse Approach to repair is patient specific Anatomy Comorbidity Tailored approach to repair is safe

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