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Ann Thorac Surg 2003;76:1962-1966
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Extraanatomic aortic bypass for repair of aortic arch coarctation via sternotomy: midterm clinical and magnetic resonance imaging results

^a Division of Thoracic and Cardiovascular Surgery, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
^b Division of Cardiovascular Surgery, Beneficência Portuguesa Hospital of São Paulo, São Paulo, Brazil

Accepted for publication June 13, 2003.

^* Address reprint requests to Dr Almeida de Oliveira, R. Barão de Bocaina, 140 Ap. 19^o, São Paulo SP 01241-020, Brazil.
e-mail: dcioliveira{at}incor.usp.br

BACKGROUND: We analyzed our 22 years of experience with extraanatomic bypass grafting for repair of aortic arch coarctation in adults. Results from early and midterm follow-up with clinical evaluation and magnetic resonance angiography are reported.

METHODS: Between November 1979 and December 2001, 18 consecutive patients aged 18 to 61 years (mean, 31.8 ± 13.3 years) underwent extraanatomic bypass grafting to repair coarctation of the aortic arch. Six patients (33.3%) had recoarctation after previous repair through a left thoracotomy, and 3 (16.7%) had associated cardiac diseases. The operative technique used in all patients was ascending aorta-to-descending thoracic aorta bypass with a polyethylene terephthalate fiber (Dacron) graft through a median sternotomy and posterior pericardial approach.

RESULTS: Follow-up was completed in all patients, with a mean duration of 5.6 ± 5.7 years (range, 12 months to 22 years). The follow-up interval exceeded 10 years in 5 patients. No neurologic complications, early or late mortality, late reoperations, or graft complications occurred. Six patients (33.3%) had mild hypertension. All patients were asymptomatic with patent Dacron grafts confirmed by echocardiography. Magnetic resonance angiography, performed in 15 (83.3%) patients, revealed that the Dacron grafts were still patent at a mean interval of 4.0 ± 6.2 years (range, 5 days to 22 years) after repair.

CONCLUSIONS: Extraanatomic ascending aorta-to-descending thoracic aorta bypass grafting for repair of aortic arch coarctation in adults is safe, with low morbidity and no mortality. The favorable midterm results indicate this technique is a safe and less invasive means of repairing aortic arch coarctation or recoarctation in adults.

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