Single Stage Repair for Aortic Coarctation associated with Intracardiac Defects Using Extra-Anatomic Bypass Graft in Adults

Abstract

Background and ObjectivesCoarctation 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 MethodsSeven 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.ResultsThe 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.ConclusionCoarctation 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.

One-stage repair of aortic coarctation and cardiac pathology via sternotomy

“…It is considered that reconstruction of the aortic isthmus via a median sternotomy is associated with increased risk of bleeding from the anastomosis and intercostal arteries during surgical dissection, chylothorax, and injury of the lung, laryngeal and phrenic nerves. 18 We did not find any statistically significant differences in perioperative data (CPB time, aortic crossclamp time, operative time, or total blood loss) between the 2 groups. However, there was a tendency for improvement in all these characteristics in the second group.…”

Our surgical strategies in repair of coarctation of aorta in adult patients and long-term follow-up

“…[19] Repair of the aortic coarctation with an ascending-to-descending bypass is safer and easier, particularly in patients with cardiac diseases associated with coarctation or recoarctation. [20][21][22] We performed ascending-to-descending bypass operations in three patients. We monitored the femoral arterial blood pressure during surgery via an arterial line, and we performed ascending aortic and femoral arterial cannulations due to need for perfusion below the coarctation in one patient.…”

A single stage approach to ascending aortic aneurysm and coarctation: Feasibility and challenges

“…A combined approach of extra anatomic bypass allows the placement of side clamp on the descending thoracic aorta and thus allows the preservation of spinal cord perfusion during the procedure. Moreover, if coarctation was operated alone first, symptoms of hemodynamic instability may occur due to the associated aortic regurgitation whereas if only the aortic valve and root are dealt with in the first stage, critical stenosis due to coarctation may result in a perfusion anomaly distally and left ventricular pressure load with congestive heart failure …”