Extraanatomic aortic bypass for repair of aortic coarctation

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Aortic coarctation repair can be complex, especially in adults with concurrent cardiovascular disorders or residual disease.
• Traditional surgical approaches may have limitations in achieving adequate perfusion and managing complex anatomies.

Observation:

• Two adult patients with aortic coarctation underwent extraanatomic ascending aorta-to-descending thoracic aorta bypass grafting.
• A median sternotomy and posterior pericardial approach were utilized for graft placement.
• Cardiopulmonary bypass was established with dual arterial cannulation (aorta/axillary and femoral) and bicaval cannulation.

Findings:

• The surgical technique involved exposing the descending thoracic aorta via the posterior pericardium.
• A 14-mm graft was anastomosed to the ascending aorta and descending thoracic aorta, ensuring adequate proximal and distal perfusion.
• One patient also underwent mitral valve repair and ascending aorta replacement concurrently.

Implications:

• This extraanatomic bypass grafting technique offers a viable solution for complex aortic coarctation repair in adult patients.
• The described surgical approach facilitates adequate perfusion and can be combined with other cardiovascular procedures.
• This method expands the surgical armamentarium for treating challenging cases of aortic coarctation.