[Extra-anatomic bypass for complex aortic coarctation in adults]
Xu-dong Pan1, Si-hong Zheng, Yi-peng Ge
1Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital University of Medical Sciences, Beijing 100029, China.
Insights
Extra-anatomic bypass effectively treats complex aortic coarctation in adults, improving blood pressure and hypertension. This surgical option demonstrates safe and patent grafts during follow-up.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Context:
- Complex aortic coarctation presents significant challenges in adult patients.
- Surgical intervention is often necessary to manage severe cases of aortic coarctation.
- Extra-anatomic bypass offers an alternative surgical approach for aortic reconstruction.
Purpose:
- To evaluate the efficacy and safety of extra-anatomic bypass for complex adult aortic coarctation.
- To assess perioperative outcomes and long-term graft patency.
- To determine the impact on blood pressure and hypertension management.
Summary:
- Fifty-one adult patients with complex aortic coarctation underwent extra-anatomic aortic bypass (ascending-to-descending, abdominal, or femoral aorta bypass).
- Concomitant procedures included aortic valve and root replacements, ascending aorta replacement, and coronary artery bypass grafting.
- Mean follow-up was 30 months, showing significant blood pressure improvement, well-controlled hypertension, and patent grafts without complications.
Impact:
- Extra-anatomic bypass is a safe and effective surgical strategy for complex aortic coarctation in adults.
- The procedure leads to significant improvements in upper-extremity blood pressure and hypertension control.
- Long-term graft patency is high, with no instances of obstruction or pseudoaneurysm formation observed.
Objective:
To demonstrate an effective operation of extra-anatomic bypass for complex aortic coarctation in adults.
Methods:
Between July 1997 and October 2010, 51 patients underwent extra-anatomic aortic bypass. There were 39 male and 12 female patients. Mean age was (40 ± 14) years (ranging from 18 to 63 years). Operative technique of extra-anatomic bypass consisted of performing an ascending-to-descending or abdominal or femoral aorta bypass (8, 39 and 4 patients). Concomitant procedures were performed in 38 patients: 10 isolated aortic valve replacements (AVR), 11 aortic root replacements (Bentall), 4 ascending aorta replacements including 3 concomitant AVR, 5 mitral valve replacements including 3 concomitant AVR, 4 ventricular septal defect correcting with AVR, and 4 coronary artery bypass graft.
Results:
Mean follow-up time was (30 ± 9) months (ranging from 5 to 60 months). Two patients were reoperated for hemorrhage in descending aorta anastomosis, one of whom was dead of multiple organ failure in perioperative period. Upper-extremity blood pressure after coarctation correction with extra-anatomic aortic bypass was significantly improved (< 10 mmHg, 1 mmHg = 0.133 kPa). Arterial hypertension was well improved, except 10 patients controlled with less drug therapy. All grafts were patent without obstruction or pseudoaneurysm formation in the follow-up period evaluated by vascular ultrasound and computed tomographic angiogram.
Conclusion:
Extra-anatomic aortic bypass is a safe and effective option for complex aortic coarctation in adults.
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