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Lookup NU author(s): Dr Brian Watson,
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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 degreesC 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 mu mol/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. (C) 2001 Elsevier Science B.V. All rights reserved.
Author(s): Wong CH, Watson B, Smith J, Hamilton JRL, Hasan A
Publication type: Article
Publication status: Published
Journal: European Journal of Cardio-Thoracic Surgery
ISSN (print): 1010-7940
ISSN (electronic): 1873-734X
Publisher: Oxford University Press
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