Total Simultaneous Repair of Coarctation and Intracardiac Pathology in Adult Patients

Single-Stage Repair of a Critical Aortic Coarctation, a Bicuspid Aortic Stenosis and an Ascending Aortic Aneurysm

“…The second alternative is a double-stage procedure using sternotomy and thoracotomy. The third option is a single-stage simultaneous repair of all pathologies by a single incision: median sternotomy [2] [5]- [7].…”

“…Ananiadou reported excellent results with no surgical mortality or graft-related complications [3]. Thanks to lateral partial aortic clamp that allows continuation of blood flow to the posterior wall of the aorta, paraplegia is rarely described with the extra-anatomic bypass [2] [4] [8]. Connolly has reported no serious complications with this technique and especially no cases of spinal cord ischemia [1].…”

“…Connolly has placed the graft between the inferior vena cava and the right inferior pulmonary vein, which keeps the graft in a posterior location avoiding compression of the right atrium [1]. The extra-anatomic bypass seems to be a relatively safe alternative that allows simultaneous repair of intracardiac lesions and AC, avoids the hemodynamic perturbation of the second lesion in case of staged procedure and provides good results [1] [2]. Although, this approach can sometimes be responsible of complications; in 1996, Pethig [1] [14] reported hemodynamic instability in 2 patients early after aortic valve replacement and extra-anatomic bypass for AC.…”

“…The best surgical approach is still uncertain since there are no guidelines about this topic [1]. However, it seems that the single-stage approach for simultaneous repair of cardiac lesions and ascending-to-descending aortic extra-anatomic bypass through median sternotomy is a safe technique, which avoids the complications of the anatomic repair and the double-stage surgery [2] [3]. The aim of this observation is to underline the excellent result of the single-stage surgery with a long term patency of the extraanatomic graft.…”

Aortic valvular insufficiency and postductal aortic coarctation with small aorta syndrome: one-stage surgical management using extra anatomic bypass through median sternotomy

“…The singlestep repair provides an alternative to the traditional twostage approach and may be life-saving in patients with severe combined lesions. [4][5][6] In approximately 5% of patients, the infrarenal aorta, iliac, and femoral vessels are small or hypoplastic, which may make aortic reconstruction technically difficult. Cronenwatt et al have defined the syndrome as characterized by an infrarenal aorta measuring less than 13.2 mm just below the renal arteries or smaller than 10.3 mm just above the aortic bifurcation.…”