Extra-anatomical ascending-to-descending aortic bypass in an adult patient with aortic coarctation
Gvido Varpins1,2, Eduard Quintana3,4, Nikola Caune2
1Pauls Stradiņš Clinical University Hospital, Center of Cardiac surgery, Riga, Latvia
Insights
Adults with aortic coarctation can benefit from extra-anatomical ascending-to-descending aortic bypass surgery. This median sternotomy approach offers a safe and effective treatment for complex cases, improving hemodynamics and patient recovery.
Area of Science:
- Cardiovascular Surgery
- Adult Congenital Heart Disease
Background:
- Aortic coarctation, typically diagnosed in infancy, can present in adulthood with severe risks like myocardial infarction and heart failure.
- Adult cases often require complex cardiac interventions, making surgical approach critical.
Purpose of the Study:
- To present a case of successful extra-anatomical ascending-to-descending aortic bypass via median sternotomy in an adult with severe aortic coarctation.
- To highlight the safety and effectiveness of this surgical technique in complex adult aortic coarctation.
Main Methods:
- A 55-year-old woman with severe aortic coarctation underwent an extra-anatomical bypass using a 16mm interposition graft.
- The graft was routed via median sternotomy, connecting the ascending and descending aorta.
- Pre- and post-operative imaging (echocardiography, CT) and intra-operative hemodynamics were assessed.
Main Results:
- The patient experienced immediate hemodynamic improvement with normalized upper and lower body pressures post-surgery.
- Post-operative imaging confirmed correct graft placement without complications.
- The patient recovered uneventfully and was discharged on post-operative Day 12.
Conclusions:
- Extra-anatomical ascending-to-descending aortic bypass via median sternotomy is a safe and effective option for adult aortic coarctation.
- This approach provides a viable alternative to thoracotomy, especially in anatomically and surgically complex scenarios.
- It reduces risks associated with spinal cord ischemia and recurrent laryngeal nerve injury.
Abstract:
Aortic coarctation is typically diagnosed in infancy, but some cases present in adulthood, posing significant risks including aortic dissection, myocardial infarction and heart failure. In adults requiring complex aortic or cardiac interventions, extra-anatomical ascending-to-descending aortic bypass via median sternotomy is a preferred surgical option due to its reduced risk of spinal cord ischaemia and recurrent laryngeal nerve injury. We present the case of a 55-year-old woman with lifelong hypertension and severe headaches. Transthoracic echocardiography revealed a significant narrowing at the aortic isthmus with elevated peak velocity and pressure gradients. Contrast-enhanced computed tomography confirmed 80% narrowing without aneurysmal changes. The patient underwent an extra-anatomical bypass using a 16mm interposition graft via median sternotomy. The graft was routed behind the left ventricle and over the left pulmonary artery to connect the ascending and descending aorta. Intra-operative haemodynamic improvement was immediate, with normalization of upper and lower body pressures. Post-operative imaging confirmed correct graft positioning without stenosis or kinking. The patient recovered uneventfully and was discharged on post-operative Day 12. This case demonstrates the safety and effectiveness of extra-anatomical bypass via sternotomy in adult coarctation, offering a viable alternative to thoracotomy in anatomically and surgically complex scenarios.
