Extraanatomic aortic bypass grafting for the treatment of complex aortic coarctation

Abstract

To review the experience of extraanatomic aortic bypass grafting for the treatment of complex aortic coarctation. From July 1997 to July 2008, 48 consecutive patients (median age 30 years; range 10 to 58 years) with complex aortic coarctation underwent extraanatomic aortic bypass grafting. Indications include: (1) coarctation with intracardiac anomaly (n = 28); (2) coarctation with ascending aortic aneurysm (n = 1); (3) adult coarctation with calcification of local aortic wall (n = 7); (4) coarctation with hypoplasia aortic arch (n = 4); (5) long or multiple coarctation segment (n = 4); (6) coarctation with poststenotic aneurysm (n = 1); and (7) recurrent coarctation (n = 3). Routing of the grafts was:ascending-to-posterior pericardial descending aorta (n = 37); ascending-to-infrarenal abdominal aorta (n = 9); left subclavian artery-to-descending aorta(n = 2). Concomitant cardiac operations were performed in 31 patients (65%) using cardiopulmonary bypass; procedures included: aortic valve replacement in 16; mitral valve repair or replacement in 9; Bentall procedures in 6; patent ductus arteriosus closure in 5; ascending aortic replacement or plasty in 4; ventricular septal defect closure in 3 and coronary artery bypass surgery in 2. There was no operative death. One patient died of septic shock 39 days postoperatively. Two patients received laparotomy because of mechanical ileus shortly after the ascending-to-subrenal abdominal aortic bypass. Mean systolic blood pressure gradient between upper and lower extremities decreased from (65 +/- 27) mm Hg preoperatively to (14 +/- 11) mm Hg postoperatively (P < 0.05). During a mean follow-up of 28.9 months, there were no late deaths or graft-related complications. Residual mild hypertension were observed in five patients. Extraanatomic aortic bypass is an attractive treatment option for complex aortic coarctation in adults and adolescents. It can be performed with low morbidity and mortality. The midterm results is favorable.