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Original Articles: Cardiovascular

Invited Commentary

Department of Cardiothoracic Surgery, Stanford University Medical Center, Falk CVRC, 300 Pasteur Dr, Stanford, CA 94305

(Email: rsmitch{at}stanford.edu).

The report by Schoenhoff and colleagues [1] is an interesting one, as it presents a relatively simple solution for a difficult problem, that of complex recurrent aortic coarctation and hypoplastic aortic arch pathologies. The described technique seems technically reproducible with low risk, clearly desirable for many complex repeat reconstructions, which can be quite challenging.

Although graft size was stated to match the size of the descending thoracic aorta, grafts 16 mm or smaller were used in 6 patients, and 14 mm or smaller for 3 patients. Obviously, adequacy of graft size depends on patient size and growth potential; nevertheless, these graft sizes seem small. It would be reassuring to know that no significant gradient existed between the brachiocephalic vessels and the abdominal aorta at rest and with exercise.

A second concern with this report is the inclusion of 3 patients with bicuspid aortic valve syndrome. Approximately 50% of these patients will have abnormal aortic dilation extending from the sinuses of Valsalva into the aortic arch, requiring at least a hemiarch reconstruction to exclude all abnormal aortic tissue. Because none of these patients appeared to have had a previous operation, a conventional inline surgical repair involving total arch reconstruction using cardiopulmonary bypass and circulatory arrest with antegrade cerebral perfusion would seem only a modest increment over the open distal anastomosis with hemiarch reconstruction necessary for the bicuspid aortic valve patients, and with a very low incidence of spinal cord complications. For the management of complex recoarctation, however, this technique would seem a valuable addition to ones’ armamentarium.

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1. Schoenhoff FS, Berdat PA, Pavlovic M, et al. Off-pump extraanatomic aortic bypass for the treatment of complex aortic coarctation and hypoplastic aortic arch Ann Thorac Surg 2008;85:460-464.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mitchell, R. S. Search for Related Content PubMed PubMed Citation Articles by Mitchell, R. S. Related Collections Congenital - acyanotic Related Article