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Original Articles: Cardiovascular

Off-Pump Extraanatomic Aortic Bypass for the Treatment of Complex Aortic Coarctation and Hypoplastic Aortic Arch

^a Department of Cardiovascular Surgery, University of Berne, Berne, Switzerland
^b Division of Pediatric Cardiology, University of Berne, Berne, Switzerland
^c Department of Cardiology, University of Berne, Berne, Switzerland

Accepted for publication October 18, 2007.

^_* Address correspondence to Dr Carrel, Department of Cardiovascular Surgery, University Hospital Berne, Berne, Freiburgstrasse 3010, Switzerland (Email: thierry.carrel{at}insel.ch).

Background: Despite advances in surgical and interventional techniques, the optimal surgical treatment of severe aortic (re) coarctation and hypoplastic aortic arch is still controversial. Anatomic repair may require extensive dissection, cardiopulmonary bypass, and deep hypothermic circulatory arrest with their inherent risks. The aim of this study was to analyze the outcome of off-pump extraanatomic aortic bypass as a surgical alternative to local repair.

Methods: From February 2000 to December 2005, ten consecutive patients (median age 20 years; range, 11 to 38 years) with severe aortic (re) coarctation (n = 4) and (or) hypoplastic aortic arch (n = 7) underwent off-pump extraanatomic aortic bypass through median sternotomy. All but three patients had undergone previous surgery for coarctation and angioplasty or stenting. Three patients underwent concomitant replacement of the ascending aorta because of an aneurysm using cardiopulmonary bypass.

Results: Postoperative hospital course was uneventful in all patients. There was no perioperative mortality or significant morbidity. During a mean follow-up of 48 ± 22 months no patient required additional procedures. All patients were free of symptoms; no patient showed signs of heart failure after follow-up. At last follow-up, no patient presented with claudication, nor any patient experienced orthostatic problems due to a steal phenomenon. During follow-up, hypertension resolved in all patients with residual mild hypertension in two patients.

Conclusions: Off-pump extraanatomic aortic bypass is an attractive treatment option for complex aortic (re) coarctation and hypoplastic aortic arch. Perioperative risks are minimized, hypertension is influenced favorably, and midterm survival is event-free.

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Ann. Thorac. Surg. 2008 85: 464. [Extract] [Full Text] [PDF]

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				R. S. Mitchell Invited Commentary Ann. Thorac. Surg., February 1, 2008; 85(2): 464 - 464. [Full Text] [PDF]