Bypass graft for complex forms of isthmic aortic coarctation in adults
J M Grinda1, L Macé, P Dervanian
1Department of Cardiovascular and Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris, France.
Insights
Bypass grafting is a safe alternative for complex coarctation repair, showing no hospital mortality and excellent long-term graft patency. Lateroisthmic bypass is preferred over ascending aorta-descending aorta bypass.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Pediatric Cardiology
Background:
- Complex coarctation of the aorta presents high complication rates with traditional anatomic repair.
- Bypass grafting is an under-documented alternative for complex coarctation of the aorta.
- This study evaluates bypass grafting for complex aortic coarctation.
Purpose of the Study:
- To assess the safety and efficacy of bypass grafting for complex coarctation of the aorta.
- To compare lateroisthmic bypass grafting with ascending aorta-descending aorta bypass grafting.
Main Methods:
- 16 patients with complex isthmic aortic coarctation underwent bypass grafting between 1980 and 1994.
- Procedures included lateroisthmic bypass (n=14) and ascending aorta-descending aorta bypass (n=2).
- Indications included atypical coarctation forms and reoperations.
Main Results:
- No hospital mortality was observed.
- Postoperative morbidity included paradoxical hypertension in 3 patients; no spinal cord complications occurred.
- All patients remained asymptomatic with patent grafts at a mean follow-up of 5.7 years.
Conclusions:
- Bypass grafting is a safe alternative for select patients with complex coarctation of the aorta.
- Lateroisthmic bypass grafting is the preferred initial procedure.
- Ascending aorta-descending aorta bypass grafting is reserved for cases of lateroisthmic bypass failure.
Background:
Bypass grafting for complex forms of coarctation has been poorly documented as an alternative to decrease the high complication rate associated with anatomic repair.
Methods:
Between mid-1980 and the end of 1994, 16 patients underwent bypass grafting for complex forms of isthmic aortic coarctation. Age ranged from 11 to 49 years (mean age, 28.4 +/- 13 years). Indications were atypical anatomic forms of coarctation (n = 12) and reoperation after multiple or complicated previous coarctation repair (n = 4). Lateroisthmic bypass grafts were performed in 14 patients and ascending aorta-descending aorta bypass grafts in 2.
Results:
There was no hospital mortality. Morbidity consisted of postoperative paradoxical hypertension in 3 patients. There were no spinal cord complications. One death 10 years postoperatively was unrelated to the surgical technique. One patient successfully underwent ascending aorta-descending aorta bypass grafting for a false aneurysm 10 years after lateroisthmic grafting. All patients were asymptomatic and all grafts, patent after a mean follow-up of 5.7 +/- 4 years.
Conclusions:
On the basis of these results, bypass grafting appears to be a safe alternative in this select group of patients. The lateroisthmic bypass graft is the procedure of first choice, and the ascending aorta-descending aorta bypass graft should be reserved for failure of previous lateroisthmic bypass grafting.
