Surgery of chronic XXXX of the aortic isthmus: benefit of direct suture.

@entity1 @entity1755 @entity439 @entity451 @entity130
OBJECTIVE: Retrospective evaluation of long term results after direct suture repair of chronic @entity439 of the aortic isthmus. METHODS: From March 1979 to June 1998, a total of 19 @entity1 with chronic @entity439 of the aortic isthmus were operated on, among whom 12 (63%) underwent direct suture. These 12 @entity1 (age ranging from 19 to 68 years; mean 34.2 years) constitute the subject of this study. All but one suffered traffic accidents. Mean delay between @entity130 and surgery was 4 years (range 3 months to 12 years). All @entity1 underwent a left posterolateral thoracotomy through the fourth intercostal space. Extracorporeal circulation for spinal cord protection was installed in six @entity1 (five ilio-iliac shunts, one atrio-iliac shunt). @entity1755 was partial in five and circumferential in seven @entity1 . The mean clamping time was 25 min. The absence of loss of aortic substance and a careful mobilization of the aorta made the repair by direct suture easier; this technique could thus be achieved in 63.2% of all 19 @entity1 operated on of chronic @entity439 within the same period. RESULTS: There was no in-hospital death and no postoperative @entity451 . With a median follow-up of 15 years 3 months (ranging from 22 to 10 years), there were no late complications. Chest X-ray was normal in all @entity1 ; eight of them underwent a control angiography between 18 and 72 postoperative months; all these angiographies but one (20% stenosis without gradient) demonstrated a normal appearance of aortic isthmus. CONCLUSION: Direct suture for repair of chronic @entity439 is a safe procedure: long-term outcome was excellent and the complications observed with prosthetic grafts or with aortic endoprosthetic stent-grafts were avoided.
