Thorac Cardiovasc Surg 2007; 55 - V_41
DOI: 10.1055/s-2007-967321

Off-pump extraanatomic aortic bypass for the treatment of complex aortic coarctation and hypoplastic aortic arch

F Schoenhoff 1, M Pavlovic 2, M Schwerzmann 3, JP Pfammatter 2, TP Carrel 1, PA Berdat 1
  • 1University Hospital Bern, Clinic for Cardiovascular Surgery, Bern, Switzerland
  • 2University Hospital Bern, Department of Paediatric Cardiology, Bern, Switzerland
  • 3University Hospital Bern, Department of Cardiology, Bern, Switzerland

Objective: Despite advantages in management of patients with severe (re-) coartation and hypoplastic aortic arch, the definite surgical strategy is still issue of ongoing debate. Local repair often enough requires extensive dissecting, cardiopulmonary bypass and deep-hypothermic-circulatory-arrest (DHCA) and is associated with a high incidence of perioperative complications. Orthotopic ascending-to-descending aortic bypass is a favourable option and superior to local repair for this patient population but prone to failure due to graft-tension in the growing child.

Methods: From 02/2000 to 12/2005 11 consecutive patients (median age 20 years, range 11–38 years) with severe aortic (re-) coarctation (n=4) or hypoplastic aortic arch (n=7) underwent extraanatomic-aortic-bypass through median sternotomy. All but 3 patients had undergone previous surgery at least one time using resection and end-to-end anastomosis, subclavian-flap or patch-aortoplasty or interposition of a polyester-tube graft. Two patients had a history of angioplasty and stenting. Three patients additionally underwent replacement of the ascending aorta due to large aneurysms using cardiopulmonary-bypass.

Results: Postoperative hospital course was uneventful in all patients. There was no case of spinal cord ischemia. Perioperative mortality was zero. Follow-up was performed using two-dimensional- echocardiography and magnetic-resonance-imaging when appropriate. During a mean follow-up period of 34±22 months, no patient needed redo-surgery or intervention for recoarctation.

Conclusion: Extraanatomic-aortic-bypass is an excellent treatment modality for complex aortic coarctation and hypoplastic aortic arch especially in patients with concomitant cardiac diseases and a history of surgery on the thoracic aorta. Avoidance of cardiopulmonary-bypass, re-thoracotomy and extensive dissecting diminishes perioperative risk and improves postoperative outcome.