Off-pump extraanatomic aortic bypass for the treatment of complex aortic coarctation and hypoplastic aortic arch.
BACKGROUND
Despite advances in surgical and interventional techniques, the optimal surgical treatment of severe aortic (re) coarctation and hypoplastic aortic arch is still controversial. Anatomic repair may require extensive dissection, cardiopulmonary bypass, and deep hypothermic circulatory arrest with their inherent risks. The aim of this study was to analyze the outcome of off-pump extraanatomic aortic bypass as a surgical alternative to local repair.


METHODS
From February 2000 to December 2005, ten consecutive patients (median age 20 years; range, 11 to 38 years) with severe aortic (re) coarctation (n = 4) and (or) hypoplastic aortic arch (n = 7) underwent off-pump extraanatomic aortic bypass through median sternotomy. All but three patients had undergone previous surgery for coarctation and angioplasty or stenting. Three patients underwent concomitant replacement of the ascending aorta because of an aneurysm using cardiopulmonary bypass.


RESULTS
Postoperative hospital course was uneventful in all patients. There was no perioperative mortality or significant morbidity. During a mean follow-up of 48 +/- 22 months no patient required additional procedures. All patients were free of symptoms; no patient showed signs of heart failure after follow-up. At last follow-up, no patient presented with claudication, nor any patient experienced orthostatic problems due to a steal phenomenon. During follow-up, hypertension resolved in all patients with residual mild hypertension in two patients.


CONCLUSIONS
Off-pump extraanatomic aortic bypass is an attractive treatment option for complex aortic (re) coarctation and hypoplastic aortic arch. Perioperative risks are minimized, hypertension is influenced favorably, and midterm survival is event-free.
Schoenhoff
Florian S
FS
Department of Cardiovascular Surgery, University of Berne, Berne, Switzerland.
Berdat
Pascal A
PA
Pavlovic
Mladen
M
Kadner
Alexander
A
Schwerzmann
Markus
M
Pfammatter
Jean-Pierre
JP
Carrel
Thierry P
TP
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001015:Aortic Arch Syndromes / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass / Q000379:methods; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D011182:Postoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome