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Ascending-to-descending bypass for simultaneous surgery of aortic coarctation with other cardiac pathologies
W Reents1, S Froehner, A Diegeler
1Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
Insights
Simultaneous surgery for aortic coarctation and other heart conditions using an ascending-to-descending aortic bypass via median sternotomy shows excellent early and long-term results with no mortality and improved patient function.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Congenital Heart Disease
Background:
- The optimal surgical strategy for aortic coarctation (CoA) combined with other cardiac conditions requiring intervention remains debated.
- Simultaneous surgical repair aims to address both conditions concurrently, potentially improving patient outcomes.
Purpose of the Study:
- To evaluate the outcomes of simultaneous surgery for aortic coarctation and concomitant cardiac diseases.
- To assess the efficacy and safety of an extra-anatomical ascending-to-descending aortic bypass performed via median sternotomy alongside other cardiac procedures.
Main Methods:
- A cohort of 13 patients with aortic coarctation and other cardiac diseases underwent simultaneous surgery between 1999 and 2009.
- Procedures included an extra-anatomical ascending-to-descending aortic bypass for CoA repair, combined with various other cardiac surgeries (e.g., valve replacement/repair, CABG).
- Median sternotomy was the surgical approach for all patients.
Main Results:
- No early mortality was observed; only one late death occurred during up to 11 years of follow-up.
- Significant improvement in New York Heart Association (NYHA) functional class from 2.4 to 1.2.
- Absence of pressure gradients between upper and lower extremities post-surgery, indicating durable bypass function and effective CoA repair.
Conclusions:
- Ascending-to-descending aortic bypass can be safely performed simultaneously with other cardiac procedures via median sternotomy.
- This combined approach yields excellent operative and long-term results.
- The procedure is recommended as the preferred option for patients with aortic coarctation and coexisting cardiac diseases requiring surgery.
Background:
The appropriate approach for aortic coarctation associated with other cardiac diseases necessitating surgery is still controversial. The aim of this study was to evaluate the results after simultaneous surgery performed via median sternotomy and consisting of extra-anatomical ascending-to-descending aortic bypass and various other cardiac procedures.
Methods:
Between January 1999 and February 2009, 13 consecutive patients with aortic coarctation coexistent with other cardiac diseases necessitating surgery underwent simultaneous surgery via median sternotomy. An extra-anatomical ascending-to-descending aortic bypass for coarctation repair was performed in all patients accompanied by various cardiac procedures (5 aortic root and valve replacement; 2 aortic valve replacement; 2 coronary artery bypass grafting; 2 mitral valve repair; 1 aortic valve replacement and coronary artery bypass grafting; 1 mitral and tricuspid valve repair). There were 3 women and 10 men with a mean age of 52 years (range 25-69). Two patients had recurrent or residual coarctation 37 and 46 years after previous surgical repair, respectively.
Results:
Early mortality was 0 and there was only 1 late death during the follow-up of up to 11 years. New York Heart Association (NYHA) functional class improved on average from 2.4 to 1.2. At the last follow-up, blood pressure measured at the upper and lower extremities showed no gradient in any patient, indicating a durable function of the extra-anatomical bypass. Only 3 patients were on reduced antihypertensive therapy; 8 patients were on the same medication and 1 patient required increased medication therapy compared with the medication prior to surgery.
Conclusions:
Ascending-to-descending bypass can be performed via median sternotomy simultaneously with various cardiac procedures without considerable extension of the procedure. The operative and long-term results are excellent, and this approach can be recommended as the procedure of choice in patients with aortic coarctation and additional cardiac diseases necessitating surgery.
