Impact of ascending to descending aortic bypass for aortic coarctation on 3-dimensional hemodynamics.

Abstract

In the management of aortic coarctation, endovascular techniques and surgical repair have been shown to have similar short-term morbidity.1 However, further studies have shown that, in patients with coarctation that are complex or have previously undergone surgical repair, an ascending-descending aortic bypass surgery is effective in decreasing future interventions.2 We present postoperative findings in a 67-year-old female patient after ascending-descending aortic bypass surgery for recurrent aortic coarctation. The patient has a history of aortic coarctation for which she underwent 2 separate surgical corrections via thoracotomies as a child (at 5 and 16 years of age). Her preoperative computed tomography scan (Figure 1A) revealed a stenotic segment with an aneurysmal dilated area between the left common carotid artery to just distal of the left subclavian artery. Cardiac catheterization demonstrated a 40 mm Hg peak gradient across the stenotic segment, and aneurysmal degeneration of the proximal descending thoracic aorta, as well. Because of the complex anatomy from the recurrent coarctation and associated aneurysm, repair via endovascular stenting was not favored. The 2 operative approaches considered included (1) resection with interposed graft reconstruction and (2) ascending to descending aortic bypass. Given the expected dense adhesions, and the concern for the inability to gain proximal control of the aorta from …