title: Off-pump extraanatomic bypass from the ascending to the descending aorta for re-operation of interrupted aortic arch in an adolescent.
abstract: 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.
authors.affiliation: Department of Pediatric Cardiology, University of Munich, Munich, Germany.
authors.forename: Nora
authors.initials: N
authors.lastname: Lang
authors.forename: Ralf
authors.initials: R
authors.lastname: Sodian
authors.forename: Edward
authors.initials: E
authors.lastname: Malec
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Januszewska
authors.forename: Rainer
authors.initials: R
authors.lastname: Kozlik-Feldmann
authors.forename: Robert
authors.initials: R
authors.lastname: Dalla Pozza
authors.forename: Armin M
authors.initials: AM
authors.lastname: Huber
authors.forename: Jan
authors.initials: J
authors.lastname: Abicht
authors.forename: Christian
authors.initials: C
authors.lastname: Kowalski
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
authors.forename: Heinrich
authors.initials: H
authors.lastname: Netz
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
mesh_terms: 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