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Ann Thorac Surg 1991;52:1281-1284
© 1991 The Society of Thoracic Surgeons

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Articles

Treatment of aortic coarctation by axillofemoral bypass grafting in the high-risk patient

Division of Cardiothoracic Surgery and Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, New York USA

Accepted for publication June 25, 1991.

^_* Address reprint requests to Dr Connery, Division of Cardiothoracic Surgery, University of Rochester Medical Center, PO Box SURG, 601 Elmwood Ave, Rochester, NYM 14642 USA.

Operative correction of coarctation of the aorta has been performed for 45 years. Reoperation for recurrent coarctation is necessary in as many as 5% to 10% of patients. Repair of recurrent coarctation carries an operative mortality of between 5% and 10%. Coarctation repair involves an increased risk in patients with advanced age, recurrent coarctation, congestive heart failure, and pulmonary disease. We report 3 cases where axillofemoral bypass has been used to treat high-risk patients with aortic coarctation. Two patients had had previous coarctation repair in addition to serious medical problems. Another patient had suffered three myocardial infarctions and had disabling congestive heart failure. All patients had an immediate marked decrease in their preoperative peak systolic pressure gradient across the coarctation. Systemic hypertension and symptoms of congestive heart failure were improved in all patients. The length of follow-up was 15 months, 8.5 years, and 10.5 years. Reassessment with noninvasive vascular segmental pressure studies with and without an exercise component showed no recurrence of the pressure gradient. This procedure should be considered when treating coarctation of the aorta in the high-risk adult.

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