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Extra-anatomic aortic bypass via sternotomy for complex aortic arch stenosis in children
K R Kanter1, E Erez, W H Williams
1Division of Cardio-Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. kkanter@emory.org
The Journal of Thoracic and Cardiovascular Surgery
|October 24, 2000
Summary
Extra-anatomic bypass grafting effectively manages complex aortic arch obstructions, offering a viable alternative for patients with recurrent narrowing or hypoplasia after initial repairs. This surgical technique demonstrated no mortality and no need for reoperation in a long-term follow-up study.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Recurrent aortic narrowing post-coarctation repair or interrupted aortic arch is challenging.
- Diffuse, long-segment aortic hypoplasia also presents management difficulties.
- Extra-anatomic ascending aorta-descending aorta bypass grafting is a potential alternative.
Purpose of the Study:
- To evaluate the efficacy of extra-anatomic ascending aorta-descending aorta bypass grafting.
- To assess its role in managing complex or reoperative aortic arch obstruction in pediatric patients.
Main Methods:
- Nineteen patients (2 months–18 years) underwent extra-anatomic bypass with Dacron grafts since 1985.
- Most patients had prior aortic arch surgeries (n=17).
- Cardiopulmonary bypass was used in only 6 patients.
Main Results:
- No hospital or late deaths were observed.
- No reoperations for recurrent stenosis were required during a mean follow-up of 7.9 years.
- Two patients had residual pressure gradients; one required aneurysm exclusion.
Conclusions:
- Extra-anatomic bypass is an effective and relatively straightforward approach for specific complex aortic arch obstructions.
- It should be considered as an alternative surgical technique for complex aortic arch reconstruction.