Off-pump extraanatomic bypass from the ascending to the descending aorta for re-operation of interrupted aortic arch in an adolescent.
The appearance of re-stenosis after repair of an interrupted aortic arch may be a surgical challenge due to adhesions. Here, we describe an approach using off-pump coronary artery bypass grafting techniques to reach the descending aorta through a median sternotomy in a patient with aortic arch stenosis after conduit repair. The 17-year-old patient with diagnoses of interrupted aortic arch and ventricular septal defect presented after two previous operations (one left lateral thoracotomy and one median sternotomy) with a stenosed vascular graft between ascending and descending aorta. Surgery was done via re-sternotomy without cardio-pulmonary bypass. An extraanatomic graft was used to connect ascending and descending aorta. When performing the distal anastomosis, the heart was exposed using a standard suction device. This case demonstrates that the use of modern techniques may facilitate surgical approaches dramatically. In our opinion the above-described technique is the first choice for all patients requiring arch repair following multiple previous operations, performed via sternotomy and thoracotomy.
Lang
Nora
N
Department of Pediatric Cardiology, University of Munich, Munich, Germany.
Sodian
Ralf
R
Malec
Edward
E
Januszewska
Katarzyna
K
Kozlik-Feldmann
Rainer
R
Dalla Pozza
Robert
R
Huber
Armin M
AM
Abicht
Jan
J
Kowalski
Christian
C
Reichart
Bruno
B
Netz
Heinrich
H
Schmitz
Christoph
C
D000293:Adolescent; D001013:Aorta, Thoracic / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012086:Reoperation; D056346:Sternotomy / Q000379:methods; D013908:Thoracotomy / Q000379:methods