Treatment of complex coarctation and coarctation with cardiac lesions using extra-anatomic aortic bypass

• Published in: Journal of vascular surgery 2010-05, Vol.51 (5), p.1203-1208
• Main Authors: Wang, Ren, MD, Sun, Li-Zhong, MD, Hu, Xiao-Peng, MD, Ma, Wei-Guo, MD, Chang, Qian, MD, Zhu, Jun-Ming, MD, Liu, Yong-Min, MD, Yu, Cun-Tao, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - pathology; Aorta, Abdominal - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Aortic Coarctation - diagnosis; Aortic Coarctation - mortality; Aortic Coarctation - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - methods; Blood Vessel Prosthesis Implantation - mortality; Cardiology. Vascular system; Cardiopulmonary Bypass - methods; Cardiopulmonary Bypass - mortality; Cardiovascular Surgical Procedures - methods; Child; Cohort Studies; Combined Modality Therapy; Diseases of the aorta; Female; Follow-Up Studies; Heart Septal Defects, Ventricular - diagnosis; Heart Septal Defects, Ventricular - mortality; Heart Septal Defects, Ventricular - surgery; Heart Valve Diseases - diagnosis; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Laparotomy - methods; Male; Medical sciences; Middle Aged; Radiography; Retrospective Studies; Risk Assessment; Sternotomy - methods; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Young Adult
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2009.12.027

Background Coarctation of the aorta with cardiac lesions or complex coarctation is a formidable challenge for cardiac surgeons. Extra-anatomic bypass allows simultaneous intracardiac repair or an alternative approach for patients with complex coarctation. Methods Between July 1997 and March 2008, 43 patients with coarctation of the aorta underwent extra-anatomic bypass grafting, including 10 ascending-to-descending aorta bypasses and 33 ascending aorta-to-infrarenal abdominal aorta bypasses. Forty patients had additional cardiovascular disorders and concomitant procedures performed including aortic valve replacement, mitral valve replacement, coronary artery bypass grafting, closure of ventricular septal defect and patent ductus arteriosus, ascending aorta repair, and the Bentall procedure. The other three patients had complex coarctation of the aorta, including a long-segment coarctation in two cases, and descending aortic aneurysm in one. Results Two patients died perioperatively: one due to air embolism during the cardiopulmonary bypass; one due to septic shock. There were no late deaths. Complications included laparotomy for mechanical ileus in one and re-exploration for bleeding in one case. There were no strokes or paraplegia and no grafted-related complication during follow-up period. Systolic blood pressure dropped from 160 ± 27 mm Hg before surgery to 114 ± 16 mm Hg postoperatively. Only two patients with mild hypertension postoperatively needed oral medicine. Conclusions Extra-anatomic aortic bypass via median sternotomy or median sternotomy-laparotomy can be performed with low morbidity and mortality. It is a preferable single-stage approach for patients with concomitant complex coarctation and cardiovascular disorders.