title: Extraanatomic aortic bypass for repair of aortic arch coarctation via sternotomy: midterm clinical and magnetic resonance imaging results.
abstract: BACKGROUND
  We analyzed our 22 years of experience with extraanatomic bypass grafting for repair of aortic arch coarctation in adults. Results from early and midterm follow-up with clinical evaluation and magnetic resonance angiography are reported.
  
  
  METHODS
  Between November 1979 and December 2001, 18 consecutive patients aged 18 to 61 years (mean, 31.8 +/- 13.3 years) underwent extraanatomic bypass grafting to repair coarctation of the aortic arch. Six patients (33.3%) had recoarctation after previous repair through a left thoracotomy, and 3 (16.7%) had associated cardiac diseases. The operative technique used in all patients was ascending aorta-to-descending thoracic aorta bypass with a polyethylene terephthalate fiber (Dacron) graft through a median sternotomy and posterior pericardial approach.
  
  
  RESULTS
  Follow-up was completed in all patients, with a mean duration of 5.6 +/- 5.7 years (range, 12 months to 22 years). The follow-up interval exceeded 10 years in 5 patients. No neurologic complications, early or late mortality, late reoperations, or graft complications occurred. Six patients (33.3%) had mild hypertension. All patients were asymptomatic with patent Dacron grafts confirmed by echocardiography. Magnetic resonance angiography, performed in 15 (83.3%) patients, revealed that the Dacron grafts were still patent at a mean interval of 4.0 +/- 6.2 years (range, 5 days to 22 years) after repair.
  
  
  CONCLUSIONS
  Extraanatomic ascending aorta-to-descending thoracic aorta bypass grafting for repair of aortic arch coarctation in adults is safe, with low morbidity and no mortality. The favorable midterm results indicate this technique is a safe and less invasive means of repairing aortic arch coarctation or recoarctation in adults.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. dcioliveira@incor.usp.br
authors.forename: Sérgio
authors.initials: S
authors.lastname: Almeida de Oliveira
authors.forename: Luiz Augusto F
authors.initials: LA
authors.lastname: Lisboa
authors.forename: Luís Alberto O
authors.initials: LA
authors.lastname: Dallan
authors.forename: Carlos Alberto C
authors.initials: CA
authors.lastname: Abreu F
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Januário M
authors.initials: JM
authors.lastname: de Souza
mesh_terms: D000293:Adolescent; D000328:Adult; D001013:Aorta, Thoracic / Q000601:surgery*; D001017:Aortic Coarctation / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013249:Sternum / Q000601:surgery*