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Aortoaortic bypass: indications, techniques and results
B Airan1, R Mehrotra, K K Talwar
1Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi.
Insights
Ascending aorta to descending/abdominal aorta bypass grafts offer a safe and effective alternative for complex aortic obstructions. This surgical method significantly improves blood pressure and relieves symptoms without major complications.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Thoracic Surgery
Background:
- Standard surgical treatments for complex aortic obstructions present significant challenges and risks.
- Alternative surgical approaches are crucial for managing difficult aortic obstruction cases effectively.
Purpose of the Study:
- To evaluate the efficacy and safety of ascending aorta to descending/abdominal aorta bypass grafts.
- To assess the impact of this bypass technique on blood pressure and patient symptoms.
Main Methods:
- A cohort of nine patients with complex aortic obstructions underwent ascending aorta to descending/abdominal aorta bypass grafting between 1986 and 1995.
- Preoperative and postoperative blood pressure, pressure gradients, and clinical outcomes were analyzed.
Main Results:
- No hospital deaths or significant morbidity were observed.
- Significant improvement in systolic blood pressure (mean reduction of 46.5 mm Hg) and relief of pressure gradients (mean reduction of 75.2 mm Hg) were achieved.
- All patients experienced symptom relief and maintained New York Heart Association (NYHA) class I status post-procedure.
Conclusions:
- Ascending aorta to descending/abdominal aorta bypass grafting is a safe and effective alternative for complex aortic obstructions.
- This technique successfully alleviates symptoms and improves hemodynamic parameters while avoiding complications of standard procedures.
Abstract:
The standard surgical treatment of complex cases of aortic obstructions is difficult and sometimes even hazardous, thus necessitating the use of alternative surgical methods to manage these cases. Between 1986 and 1995, nine such patients underwent ascending aorta to descending/abdominal aorta bypass graft as an alternative procedure at a premier medical institution. There was no hospital death nor any significant morbidity. Preoperative systolic blood pressure in right upper limb ranged from 150 mm Hg to 230 mm Hg (mean 180.5 mm Hg) while postoperative systolic blood pressure in right upper limb ranged from 126 mm Hg to 150 mm Hg (mean 134 mm Hg), thereby showing marked improvement. Preoperative pressure gradient across the aortic obstruction ranged from 50 mm Hg to 120 mm Hg (mean 87.2 mm Hg). It was relieved in all except two patients who had resting gradients of 10 mm Hg and 12 mm Hg respectively. All the patients were relieved of their symptoms. After a mean follow-up of 33.3 months (range 6 to 108 months), all the patients are in New York Heart Association (NYHA) class I with evidence of good distal perfusion. This technique of bypassing the aortic obstruction has the added advantage of avoiding the complications associated with standard technique.