Intermediate-term results of ascending-descending posterior pericardial bypass of complex aortic coarctation
Stephen H McKellar1, Hartzell V Schaff, Joseph A Dearani
1Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Insights
This study shows that ascending-descending aortic bypass surgery is a safe and effective treatment for complex thoracic aortic disease, significantly improving blood pressure and relieving obstruction.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Disease
- Congenital Heart Defects
Background:
- Median sternotomy offers an alternative to thoracotomy for complex thoracic aortic disease.
- Extra-anatomic bypass is a viable surgical option for specific aortic conditions.
Purpose of the Study:
- To evaluate the intermediate-term outcomes of ascending-descending posterior pericardial aortic bypass.
- To assess the safety and efficacy of this approach for complex thoracic aortic disease.
Main Methods:
- Retrospective review of 50 patients with congenital or recurrent coarctation.
- Analysis of demographic data, perioperative outcomes, and long-term follow-up up to 20 years.
Main Results:
- No perioperative deaths occurred in the study cohort.
- Significant improvement in upper-extremity blood pressure post-surgery (158 to 123 mm Hg).
- No graft-related deaths or complications observed during follow-up.
Conclusions:
- Ascending-descending aortic bypass via a posterior pericardial approach is safe.
- This surgical technique effectively relieves aortic obstruction and improves hypertension.
Objective:
Extra-anatomic bypass of complex thoracic aortic disease through a median sternotomy has been reported as a safe alternative to thoracotomy. Our objective was to examine intermediate-term outcomes.
Methods:
We retrospectively reviewed 50 consecutive patients with congenital aortic coarctation or recurrent coarctation who underwent ascending-descending posterior pericardial aortic bypass between January 1985 and November 2005. Demographic data, in-hospital and postoperative morbidity and mortality, and resolution of hypertension were determined by examination of the medical record.
Results:
The mean age at operation was 42 years; 27 (54%) were men. There were no perioperative deaths. Upper-extremity blood pressure after coarctation repair with ascending-descending aortic bypass was significantly improved. Mean systolic blood pressure decreased from 158 +/- 25 mm Hg preoperatively to 123 +/- 14 mm Hg postoperatively (P < .001). There were no graft-related deaths or complications in follow-up extending up to 20 years.
Conclusions:
The ascending-descending aortic bypass through a posterior pericardial approach is a safe operation and is effective in relieving obstruction and improving hypertension.
