Late Outcomes of Ascending-to-Descending Bypass for Aortic Coarctation
Brett F Curran1, Hartzell V Schaff1, Heidi M Connolly2
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Insights
Ascending-to-descending aortic bypass is a safe and durable procedure for complex aortic coarctation, demonstrating excellent long-term survival and improvement in hypertension. This surgery does not impede future sternotomy procedures.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Congenital Heart Disease
Background:
- Ascending-to-descending aortic bypass is a surgical option for complex aortic coarctation.
- Long-term outcomes of this procedure were previously unknown.
Purpose of the Study:
- To evaluate the late outcomes of ascending-to-descending aortic bypass in adult patients with complex aortic coarctation.
- To assess the safety and durability of the procedure and its impact on systemic hypertension.
Main Methods:
- Analysis of 81 consecutive patients undergoing ascending-to-descending aortic bypass (1985-2012) with a minimum 10-year follow-up.
- Inclusion of patients with recurrent coarctation and concomitant cardiac procedures.
- Assessment of survival rates, graft patency, need for reintervention, and blood pressure control.
Main Results:
- No perioperative mortality; 20-year survival was 85%, comparable to the general population.
- No bypass-related deaths or interventions; no significant stenoses or pseudoaneurysms on late imaging.
- Improved systemic hypertension, with 50% of patients on no or single antihypertensive medication at follow-up.
Conclusions:
- Ascending-to-descending aortic bypass offers excellent long-term safety and durability for complex aortic coarctation in adults.
- The procedure effectively manages systemic hypertension and does not compromise future median sternotomy operations.
Background:
Ascending-to-descending aortic bypass is a repair option for patients with complex aortic coarctation. This technique is reported to have minimal early morbidity and mortality; however, the long-term results of the procedure are unknown.
Methods:
This study analyzed the late outcomes of 81 consecutive patients with aortic coarctation who underwent ascending-to-descending aortic bypass through a median sternotomy from January 1985 to December 2012. The study was limited to this interval to allow for a minimum of 10-year follow-up. Fifty-two patients had recurrent coarctation after previous repair, and 44 patients had concomitant cardiac procedures at the time of ascending-to-descending bypass.
Results:
There was no perioperative mortality, and overall survival at 5, 10, and 20 years was 94%, 90%, and 85%, respectively, similar to an age- and sex-matched population. There were no interventions for the ascending-to-descending bypass during follow-up, and no deaths were known to be related to the bypass graft. Subsequent cardiac operations were performed through a median sternotomy in 7 patients (9%), and late imaging in 48 patients (59%) demonstrated no hemodynamically significant stenoses or pseudoaneurysms. At late follow-up, median systolic blood pressure was 124 mm Hg, and one-half of the patients were receiving either no or only 1 antihypertensive agent.
Conclusions:
Ascending-to-descending aortic bypass is a safe operation with excellent long-term outcomes for adult patients with complex aortic coarctation. The procedure is durable and appears to improve systemic hypertension. Importantly, ascending-to-descending bypass does not hinder the safe performance of subsequent operations performed through a median sternotomy.
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