Descending aortic translocation for aerodigestive vascular compression

Patients with complex vascular ring anomalies can present with symptoms of esophageal and airway compression, occasionally persisting despite relief of the vascular ring, due to residual compression from the aorta. We report our early experience with descending aortic translocation to address aerodigestive vascular compression.

This is a retrospective single-center review of patients undergoing descending aortic translocation. The operation involves dividing the distal aortic arch on cardiopulmonary bypass, relocating the descending aorta beneath the carina and right pulmonary artery, and anastomosis to the posterior aspect of the ascending aorta, thereby entirely relieving compression on the aerodigestive tract. Concomitant esophageal mobilization and tracheopexies are performed as needed.

From 2020 to 2023, 15 patients underwent descending aortic translocation. Anatomic variants included hairpin aorta (n = 2), circumflex aorta (n = 4), midline descending aorta (n = 7), and bowstring aorta (n = 2). Median age was 2 years. Preoperatively, most patients (80%) had mixed esophageal and airway symptoms and had undergone at least 1 prior operation (60%). Intraoperative bronchoscopy revealed improved airway patency for all patients. Postoperatively, 93% of patients had relief of respiratory symptoms, and 79% of patients had improved dysphagia. Postoperative complications included neurologic event (n = 1) with full resolution, right pulmonary artery compression requiring stenting (n = 1), and need for reoperation (n = 2).

Descending aortic translocation is a novel approach that can provide symptomatic relief of aerodigestive compression related to complex aortic anomalies. For patients with persistent symptoms after initial vascular ring repair, ongoing aortic compression may need to be addressed, thus also raising the question of whether descending aortic translocation should be considered as a first-line therapy.