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Extraanatomic thoracic aortic bypass grafts: indications, techniques, and results
M K Heinemann1, G Ziemer, T Wahlers
1Department of Thoracic and Cardiovascular Surgery, Surgical Center, Hannover Medical School, Germany.
Summary
Extraanatomic thoracic aortic bypass grafts are effective for complex aortic coarctation, especially in reoperations. These bypass grafts offer a viable solution for specific aortic conditions when standard replacements are not feasible.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic replacement procedures are common, but special circumstances may necessitate extraanatomic thoracic aortic bypass grafts.
- This study analyzes the experience with 17 patients undergoing such procedures.
Purpose of the Study:
- To evaluate the efficacy and outcomes of extraanatomic thoracic aortic bypass grafts.
- To identify specific indications and graft routings for these procedures.
Main Methods:
- Retrospective analysis of 17 patients (10 female, 7 male; mean age 37.5 years) between 1988 and 1994.
- Indications included complex coarctation of the aorta (CoA), reoperation for CoA, extensive aortic occlusive disease, and complicated aneurysms.
- Various graft routings were employed, with 8 procedures involving ascending-descending aorta bypass. Eight patients underwent reoperations, and four had concomitant cardiac procedures.
Main Results:
- Three early deaths occurred, two in emergency thoracic aneurysm repairs and one after complex ascending-abdominal aortic grafting.
- Successful relief of underlying pathology was achieved in 14 survivors.
- Complications included mitral valve issues in patients with concomitant aortic valve and isthmic stenosis, and one late reoperation for an aneurysm.
Conclusions:
- Extraanatomic bypass grafts are expedient and effective for complex aortic coarctation and hypoplasia, particularly in reoperative settings.
- Their application in treating aneurysmal lesions should be considered exceptional.