Posterior pericardial ascending-to-descending aortic bypass through median sternotomy.
OBJECTIVE
Adult patients with complex forms of descending aortic disease remain a surgical challenge and have a high risk of postoperative mortality and morbidity. Surgical management may be complicated when there is an associated cardiac defect, necessitating repair, or a hostile anatomy exists. We present our experience with extra-anatomic bypass through posterior pericardial route at the same stage with intracardiac/ascending aortic aneurysm repair.


METHODS
Patients that underwent one-stage surgery with posterior pericardial bypass between ascending and descending aorta during 2003-2007 were reviewed. Data from early and mid-term follow-up, including mortality, perioperative blood loss, graft-related complications, patency, and persistent hypertension, were noted.


RESULTS
Six male patients with a mean age of 20.8 +/- 0.7 years were operated for coarctation of the aorta associated with additional pathologies (three cases of ascending aortic aneurysm-one with associated aortic valve insufficiency, one case of isolated aortic valve regurgitation, two cases of mitral valve regurgitation). No early or mid-term mortality was observed during follow-up of a mean of 21.6 +/- 10.0 months. No late graft-related complications or reoperations were observed with patent grafts. Systolic blood pressure decreased after surgery by an average of 43 mmHg.


CONCLUSIONS
Coarctation of the aorta with concomitant cardiac lesions can be repaired simultaneously through sternotomy and posterior pericardial approach, when patients present in adulthood, to minimize morbidity and mortality.
Goksel
Onur S
OS
Gulhane Military Academy of Medicine, Department of Cardiovascular Surgery, Haydarpasa, Istanbul, Turkey. onurgokseljet@gmail.com
Inan
Kaan
K
Uçak
Alper
A
Temizkan
Veysel
V
Tatar
Tolga
T
Sahin
Sinan
S
Us
Melih H
MH
Yilmaz
Ahmet T
AT
D000328:Adult; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery; D001017:Aortic Coarctation / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010496:Pericardium / Q000601:surgery*; D013249:Sternum / Q000601:surgery*; D013599:Systole