Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up

Abstract

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. #

Seventeen-year follow-up after ascending-to-infrarenal aorta bypass for recurrent coarctation in an adult

“…Although graft-related complications are possible, no large clinical series have reported graft infection or thrombosis, pseudoaneurysm formation, erosion of adjacent structures, or fistulization. [8][9][10] Percutaneous catheter-based techniques have been applied for treatment of primary and recurrent aortic coarctation, apparently with good results, but scarce information is available on its application in adults.…”

“…Extracorporeal circulation is usually used, 8 although offpump techniques have been reported. 9,10 Currently, the most widespread extra-anatomic technique is the ascendingto-descending bypass and the posterior pericardial approach to the descending thoracic aorta, first performed in 1979. 11,12 Extra-anatomic correction series show minimal morbidity and mortality rates, with good long-term results, consistent improvement in hypertension, and a low rate of paraplegia.…”

Selection of a Surgical Treatment Approach for Aortic Coarctation in Adolescents and Adults

“…In these cases, extra-anatomical bypass without CoA resection is recommended in some patients. 19) Interposition grafting is difficult in recurrent CoA repair via left thoracotomy due to adhesion. Consequently, reoperation via left thoracotomy has a high incidence of postoperative complications, with reported mortality and morbidity rates of 0−8% and 50%, respectively.…”

“…Consequently, reoperation via left thoracotomy has a high incidence of postoperative complications, with reported mortality and morbidity rates of 0−8% and 50%, respectively. 19) Since the approach for extra-anatomical bypass is performed via median sternotomy or right thoracotomy, it avoids the complications associated with repeated left thoracotomy. In addition, extra-anatomical bypass via median sternotomy can be performed even in cases where concomitant surgical repair of CoA and another cardiovascular disease is planned.…”

Late Outcomes of Reintervention on the Descending Aorta After Repair of Aortic Coarctation

“…However, although endovascular treatment for recoarctation or pseudoaneurysm has been reported frequently in the literature, [2][3][4][5][6] there are fewer institutions reporting the outcomes of operative reinterventions after coarctation repair. [7][8][9][10][11] The American College of Cardiology and American Heart Association guidelines for adults with congenital heart disease recommend percutaneous catheter intervention for recurrent discrete coarctation of the aorta. 12 Surgery is advised for long segments of recoarctation and concomitant hypoplasia of the aortic arch.…”