Extra-anatomic bypass for complex aorta coarctation

Abstract

Objective To evaluate the safety and feasibility of extra-anatomic bypass in the treatment of complex aorta coarctation concomitant with cardiac lesions, multiple stenosis of aorta or severe stenosis. Methods Complex aorta coarctation include a combination of heart disease(valve disease, coronary artery disease, ect.), or multiple constrictive lesions of the thoracic abdominal aorta or an aneurysm due to constriction of the arch, which are all difficult by interventional surgery or open thoracotomy surgery. From October 2016 to October 2017, 6 patients with complex aorta coarctation have received surgical therapy in our department, including 3 males and 3 females, with the average age( 50.0±17.9 )years old. One-staged extra-anatomic bypass was used to establish an ascending aorta to the distal aorta bypass , 4 patients underwent median thoracotomy and bypass surgery with thoracic aorta from the posterior inferior pericardium, 1 patient underwent bypass surgery with abdominal aorta through thoracoabdominal incision, and 1 patient underwent bypass surgery with bilateral femoral artery from bilateral inguinal incision and guiding with laparoscopic through peritoneal cavity. Among them, 3 patients underwent valve surgery in the same period, and 1 patient underwent coronary artery bypass surgery. Results No patient died. The mean cardiopulmonary bypass time was 273.8 minutes and the average aorta blocking time was 216.0 minutes. Pulse pressure of extremities blood pressure was significantly reduced compared with preoperative, and the clinical symptoms were significantly alleviation. During follow-up, 6 patients presented with patent artificial blood vessels and alleviated symptoms. Conclusion Extra-anatomic bypass is a safe and effective method for the treatment of complex vasoconstriction without increasing the risk of surgery. Key words: Aortic coarctation; Extra-anatomic bypass; Prosthetic vessel