Extraanatomic aortic bypass for repair of aortic arch coarctation via sternotomy: midterm clinical and magnetic resonance imaging results (original) (raw)
Related papers
Extra Anatomic Aortic Bypass Graft for Coarctation of Aorta with associated Cardiac Lesion
IOSR Journals , 2019
Coarctation of the aorta in an adult patient with associated cardiac anomaly often needs extra-anatomic bypass techniques. Among various techniques, the posterior pericardial bypass technique is commonly used,in which a Dacron conduit is anastomosed between the lateral aspect of the ascending aorta or conduit and the descending thoracic aorta posterior to the pericardium. Multiple surgical techniques have been described for the surgical treatment of adult patients with paraductal coarctation of the aorta and associated cardiac anomaly. Multiple options are, staged procedure using left thoracotomy and median sternotomy, correction of coarctation via catheter based technique along with median sternotomy, and single-stage simultaneous repair of lesions via sternotomy. We are reporting six cases of ascending aorta to descending aorta bypass without laparotomy or thoracotomy. This approach helps us to avoid surgical dissection in vicinity to the multiple colleterals and inflamed lesion and left thoracotomy which also causes bleeding from the collaterals, and to allow concomitant cardiac procedures to be performed.
Korean Circulation Journal, 2016
Background and Objectives: Coarctation of the aorta in adulthood is generally associated with other cardiovascular disorders requiring surgical management. An extra anatomic bypass grafting from the ascending to descending aorta by posterior pericardial approach via median sternotomy could be a reasonable single stage surgical strategy for these patients. Subjects and Methods: Seven male patients aged between 14-41 years underwent an extra anatomic bypass grafting for coarctation repair concomitantly with the surgical management of the associated cardiovascular disorders via median sternotomy. Preoperative mean systolic arterial blood pressure was 161.8±24.5 mmHg, although the patients were under treatment of different combinations of antihypertensive agents. Additional surgical procedures were: aortic valve replacement (n=4), ventricular septal defect (VSD) closure (n=2), ascending aortic replacement (n=3) and Bentall procedure (n=1). None of our patients have been previously diagnosed or operated on for coarctation. Data were evaluated during their hospital stay and in post-operative follow-up. Results: The post-operative course was uneventful in all but one patient was re-operated on due to bleeding. There was neither mortality nor significant morbidity during the in-hospital period and all patients were discharged within 5-9 (mean: 6.3±1.5) days. The mean follow up period was 71.83±23 months (range: 23-95 months). Unfortunately one of our patients could not be contacted for a follow up period because of invalid personal data. Conclusion: Coarctation of the aorta in adulthood associated with other cardiovascular disorders can be operated on simultaneously via an extra anatomic bypass grafting technique with low morbidity and mortality.
European Journal of Cardio-Thoracic Surgery, 2005
Objective: Operation for aortic recoarctation and/or residual hypoplastic arch represents a surgical challenge because of surrounding scar tissue in the coarctation area, hazard of spinal cord ischemia due to aortic cross-clamping, laceration of the recurrent nerve, and the choice of the best approach. We demonstrate the results of 52 operations of an extra anatomically bypass technique via right thoracotomy approach without establishment of cardiopulmonary bypass. Methods: Since 1987, 52 patients underwent extra anatomically positioned ascendingdescending bypass grafting. Indication was aortic recoarctation with concomitant hypoplastic aortic arch (45 patients), atypical coarctation of aortic arch (2 patients), congenital anomalies of aortic arch (2 patients) and concomitant aortic coarctation and associated cardiac problems that required surgical repair (2 patient), infected stent-graft of descending aorta (1 patient). Mean age was 19.3 years. Systolic pressure gradients at rest ranged from 35 to 90 mmHg; upper extremity hypertension was present in all patients. Operative technique consisted of performing aorta ascending-descending bypass graft size 16 or 18 mm in diameter, via right thoracotomy (in 51 patient) or sternotomy (in 1 patient). Results: The mortality rate was 1.9% (1/52). Five patients returned to the operating room (in 3-5 days after operation) for a lymphorrhea complication. An arterial pressure gradient in the limbs was totally corrected. During a follow-up period of actually 79G54 months, no adverse event was noticed and antihypertensive medication was stopped in all patients. Conclusions: Ascending-to-descending aortic bypass via right thoracotomy is a safe and effective method for management complex (re-) coarctation and hypoplastic aortic arch.
Indian Journal of Thoracic and Cardiovascular Surgery, 2006
Methods: We describe a simultaneous operative management of six adult patients with coarctation of aorta and associated cardiac lesion. All six patients had heterotopic bypass (Dacron tube implanted between the ascending and descending aorta) to repair the coarctation and concomitant repair of the cardiac lesion. The associated procedures were aortic valve replacement in 3 patients, coronary artery bypass grafting in 2 patients and mitral valve replacement in 1 patient.
The Annals of Thoracic Surgery, 2008
Background. Despite advances in surgical and interventional techniques, the optimal surgical treatment of severe aortic (re) coarctation and hypoplastic aortic arch is still controversial. Anatomic repair may require extensive dissection, cardiopulmonary bypass, and deep hypothermic circulatory arrest with their inherent risks. The aim of this study was to analyze the outcome of off-pump extraanatomic aortic bypass as a surgical alternative to local repair.
Alternative Surgical Approach to Repair of the Ascending Aorta
The Annals of Thoracic Surgery, 2011
cardiac problems, as performed in our case. Exposure of the descending thoracic aorta thorough the pericardium is easy with elevation of the apex and retraction of the diaphragm [8]. Graft length is short with this intrapericardial route. In our unique approach, the coarctation site was reinforced internally by the graft, and the rupture site was plugged because reversed flow from the descending aorta compressed the graft against the aortic wall. Preparatory embolization of the major intercostal arteries also proved effective.
European Journal of Cardio-Thoracic Surgery, 2008
Objective: The surgical treatment of recurrent coarctation in adults supposes a redo left thoracotomy with adhesions and high risk of bleeding and injury of adjacent nerves. The rate of paraplegia in these cases may reach 2.6%. Extra-anatomic aortic bypass avoids these complications. We present our results with ascending-to-abdominal aorta extra-anatomic bypass for recurrent aortic coarctation in adults. Methods: Between September 1979 and November 2006 12 patients underwent ascending-to-abdominal aorta bypass. There were 10 males and 2 females. Mean age was 36.2 AE 11.3 (range 21-57) years old. Mean age at primary repair was 14.3 AE 4.2 years old (range 8-21). Operative technique consisted of performing an ascending-to-abdominal aorta bypass via median sternotomy extended into the epigastrium with a supra-umbilical laparotomy through the mid-line abdominal fascia. Concomitant procedures were performed in six patients: three isolated aortic valve replacements (AVR), two ascending aorta graft replacements and one AVR associated with coronary artery bypass graft (CABG). Results: No postoperative mortality was observed. Mean follow-up time was 10.4 AE 9.3 years (range 0.3-27.8). No patients had any graft-related complication or death and all grafts were patent at the end of the follow-up. One patient developed a dilated myocardiopathy, dying at 14 years of follow-up. Four patients had persistence of arterial hypertension controlled with one drug therapy and five patients were asymptomatic. Conclusions: Ascending-toabdominal aorta extra-anatomic bypass is a safe, effective and less invasive technique for aortic recoarctation in adults with good results at longterm.
European Journal of Cardio-Thoracic Surgery, 1999
Objective: Operation for aortic recoarctation and/or residual hypoplastic arch represents a surgical challenge because of surrounding scar tissue in the coarctation area, hazard of spinal cord ischemia due to aortic cross-clamping, laceration of the recurrent nerve, and the choice of the best approach. We demonstrate the ®rst results of an anatomically guided technique via the prior left thoracotomy approach without establishment of cardiopulmonary bypass. Methods: Since 1989, ®ve patients underwent anatomically positioned ascending-descending bypass grafting for treatment of recoarctation. Indication was a non-dilatable hypoplastic aortic arch segment; in two cases an additional isthmic restenosis was present. Inclusion criteria for our technique was an aorta ascending diameter large enough to allow partial clamping. Primary repair of aortic coarctation was end-to-end anastomosis in four patients and patch angioplasty in one. Mean age at primary repair was 5.5 years and at reoperation 16.1 years. Systolic pressure gradients at rest ranged from 35 to 70 mmHg; upper extremity hypertension was present in all patients. Operative technique consisted of performing a dacron or PTFE aorta ascending-descending bypass graft parallel to the aortic arch, size 18 or 20 mm in diameter, via the prior left thoracotomy. Results: There were no intraoperative complications and all patients survived. Postoperative complications were left lung atelectasis with necessity of reintubation, pericardial effusion, and transient left diaphragm elevation, each in one patient. After 7±90 months all patients are free of symptoms, have normal blood pressure (with two patients being under anti-hypertensive medication), and have no echocardiographically measurable pressure gradients. Conclusions: Anatomically positioned aorta ascending-descending bypass grafting via the prior left posterolateral thoracotomy without cardiopulmonary bypass is a safe and ef®cient method for operation of complex recoarctation in patients with an acceptable size of the aorta ascendens.