Single Stage Repair for Aortic Coarctation associated with Intracardiac Defects Using Extra-Anatomic Bypass Graft in
Ibrahim Duvan1, Mehmet Sanser Ates1, Burak Emre Onuk1
1Department of Cardiovascular Surgery, Guven Hospital, Ankara, Turkey.
Insights
This study shows that extra-anatomic bypass grafting is a safe and effective single-stage surgical strategy for adult coarctation of the aorta with associated cardiovascular disorders, demonstrating low morbidity and mortality.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Adult Congenital Heart Disease
Background:
- Coarctation of the aorta in adults often coexists with other cardiovascular conditions.
- Surgical intervention is typically required for these complex cases.
Purpose of the Study:
- To evaluate the safety and efficacy of a single-stage surgical strategy for adult coarctation of the aorta with associated cardiovascular disorders.
- To assess the feasibility of extra-anatomic bypass grafting via a posterior pericardial approach.
Main Methods:
- Seven adult male patients (14-41 years) with coarctation of the aorta underwent extra-anatomic bypass grafting.
- Procedures were performed concomitantly with surgical management of associated conditions (e.g., aortic valve replacement, VSD closure, aortic replacement).
- Median sternotomy and posterior pericardial approach were utilized.
Main Results:
- The surgical approach was successful in all patients, with one requiring re-operation for bleeding.
- No in-hospital mortality or significant morbidity was observed.
- Patients were discharged within a mean of 6.3 days, with a mean follow-up of 71.8 months.
Conclusions:
- Extra-anatomic bypass grafting is a viable single-stage surgical option for adult coarctation of the aorta with complex cardiovascular comorbidities.
- This technique offers low morbidity and mortality, making it a reasonable strategy for selected patients.
Background And Objectives:
Coarctation of the aorta in adulthood is generally associated with other cardiovascular disorders requiring surgical management. An extra anatomic bypass grafting from the ascending to descending aorta by posterior pericardial approach via median sternotomy could be a reasonable single stage surgical strategy for these patients.
Subjects And Methods:
Seven male patients aged between 14-41 years underwent an extra anatomic bypass grafting for coarctation repair concomitantly with the surgical management of the associated cardiovascular disorders via median sternotomy. Preoperative mean systolic arterial blood pressure was 161.8±24.5 mmHg, although the patients were under treatment of different combinations of antihypertensive agents. Additional surgical procedures were: aortic valve replacement (n=4), ventricular septal defect (VSD) closure (n=2), ascending aortic replacement (n=3) and Bentall procedure (n=1). None of our patients have been previously diagnosed or operated on for coarctation. Data were evaluated during their hospital stay and in post-operative follow-up.
Results:
The post-operative course was uneventful in all but one patient was re-operated on due to bleeding. There was neither mortality nor significant morbidity during the in-hospital period and all patients were discharged within 5-9 (mean: 6.3±1.5) days. The mean follow up period was 71.83±23 months (range: 23-95 months). Unfortunately one of our patients could not be contacted for a follow up period because of invalid personal data.
Conclusion:
Coarctation of the aorta in adulthood associated with other cardiovascular disorders can be operated on simultaneously via an extra anatomic bypass grafting technique with low morbidity and mortality.
