Selection strategy and technical variations of extraanatomic bypass in surgical management of complex and recurrent aortic coarctation and hypoplastic aortic arch

Abstract

Method In 1989-2012, 60 patients (mean age 29 ± 6.7years) with complex aortic coarctation (n = 33), recurrent coarctation (n = 27; anastomosis pseudoaneurysm in 10), underwent correction using extraanatomic bypass, either or without extracorporeal circulation. The decision to use extracorporeal circulation was based on the anatomical location of the coarctation, length of hypoplasia and history of previous repair. Various extraanatomic bypass strategies included left subclavian artery (LSCA) to descending aorta (DA) (n = 38), right subclavian artery (RSCA) to left carotid artery (LCA) (n = 2), LCA to LSCA (n = 3), LCA to DA (n = 2), ascending aorta (AA) to LSCA (n = 3), AA to DA (n = 4), aortic arch to DA (n = 3) and AA to abdominal aorta (n = 5). We choose the size of the graft according to the diameter of the ascending aorta.. Preoperatively, mean systolic blood pressure was 130 ±30mm Hg at rest and 180±40 mmHg during exercise, with mean pressure gradient of 80±11.6 (range 40-120) mmHg.