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Extra-anatomic aortic bypass for complex (re-) coarctation and hypoplastic aortic arch in adolescents and adults

Pascal A Berdat1, Volkhard Göber, Thierry Carrel

  • 1Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital, CH-3010 Bern, Switzerland. pascal.berdat@insel.ch

Interactive Cardiovascular and Thoracic Surgery
|August 3, 2007
PubMed

Insights

Extra-anatomic ascending-to-descending aortic bypass (ADB) offers a safe and effective surgical solution for complex coarctation and aortic arch hypoplasia (AAH). This approach demonstrated no mortality or significant complications in seven patients, suggesting its value in select cases.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Congenital Heart Disease

Background:

  • Complex coarctation and aortic arch hypoplasia (AAH) present significant surgical challenges.
  • Existing surgical techniques may carry substantial risks, particularly in re-operations or cases requiring extensive aortic arch repair.

Purpose of the Study:

  • To evaluate the efficacy and safety of extra-anatomic ascending-to-descending aortic bypass (ADB) for complex coarctation/re-coarctation with AAH.
  • To assess outcomes in patients requiring concomitant ascending aortic or cardiac surgery or those at high risk with standard aortic arch repair.

Main Methods:

  • Retrospective review of seven patients (mean age 19.6 years) undergoing sternotomy for extra-anatomic ascending-to-descending aortic bypass (ADB).
  • Surgical intervention performed between 1995 and 2002.
  • Follow-up duration averaged 24 months (range 0.2-84 months).

Main Results:

  • Successful treatment of complex coarctation/re-coarctation and AAH in all seven patients.
  • Zero mortality occurred during the early postoperative period or follow-up.
  • No relevant complications were observed during the follow-up period.

Conclusions:

  • Extra-anatomic ascending-to-descending aortic bypass (ADB) is a viable and safe option for selected patients with complex coarctation/re-coarctation and AAH.
  • ADB is particularly beneficial when concomitant ascending aortic or cardiac surgery is needed.
  • This technique may be advantageous for patients with aortic arch stenosis at increased risk with deep hypothermic circulatory arrest (DHCA).

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