Ascending-to-descending aortic bypass: A simple solution to a complex problem

Sameh M. Said, Harold M. Burkhart, Joseph A. Dearani, Heidi M. Connolly, Hartzell V Schaff

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background Surgical correction of complex aortic coarctation can be associated with significant risks. Extraanatomic bypass may represent a safer alternative. Methods Between January 1985 and December 2012, 80 consecutive patients with complex coarctation underwent ascending-to-descending aortic bypass through a median sternotomy. Patients were a median age of 42 years (range, 15 to 75 years), and 51 (64%) were males. Recurrent coarctation was present in 52 patients (65%), with 6 (8%) having undergone balloon dilatation. Uncontrolled hypertension was present in 63 patients (79%). The most common concomitant pathology was aortic valve stenosis in 21 patients (26%), subaortic stenosis in 10 (13%), and Shone complex in 4 (5%). Results There were no early deaths. The most common concomitant procedures were aortic valve replacement, coronary artery bypass grafting, and resection of subaortic stenosis. The mean aortic cross-clamp and cardiopulmonary bypass times were 33 ± 40 and 106 ± 54 minutes, respectively. Morbidity included atrial fibrillation in 17 patients (21%) and reexploration for bleeding in 6 (8%). There was no paraplegia or stroke. Upper extremity blood pressure significantly improved (p < 0.001). Mean systolic blood pressure decreased from 153 ± 26 mm Hg preoperatively to 123 ± 15 mm Hg postoperatively. Mean follow-up was 7 ± 6 years (maximum, 22 years). Late deaths occurred in 5 patients (6%) and were not graft-related. Three patients (4%) required reoperation for repair of periprosthetic regurgitation in 2 and mitral valve replacement in 1. Conclusions The ascending-to-descending aortic bypass can be performed with low morbidity and mortality. It is an effective solution to complex aortic coarctation and represents a safe single-stage approach for patients with concomitant cardiac pathology.

Original languageEnglish (US)
Pages (from-to)2041-2048
Number of pages8
JournalAnnals of Thoracic Surgery
Volume97
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Aortic Coarctation
Blood Pressure
Pathologic Constriction
Pathology
Morbidity
Sternotomy
Paraplegia
Aortic Valve Stenosis
Cardiopulmonary Bypass
Aortic Valve
Mitral Valve
Reoperation
Upper Extremity
Coronary Artery Bypass
Atrial Fibrillation
Dilatation
Stroke
Hemorrhage
Hypertension
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Ascending-to-descending aortic bypass : A simple solution to a complex problem. / Said, Sameh M.; Burkhart, Harold M.; Dearani, Joseph A.; Connolly, Heidi M.; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 97, No. 6, 2014, p. 2041-2048.

Research output: Contribution to journalArticle

Said, Sameh M. ; Burkhart, Harold M. ; Dearani, Joseph A. ; Connolly, Heidi M. ; Schaff, Hartzell V. / Ascending-to-descending aortic bypass : A simple solution to a complex problem. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 6. pp. 2041-2048.
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abstract = "Background Surgical correction of complex aortic coarctation can be associated with significant risks. Extraanatomic bypass may represent a safer alternative. Methods Between January 1985 and December 2012, 80 consecutive patients with complex coarctation underwent ascending-to-descending aortic bypass through a median sternotomy. Patients were a median age of 42 years (range, 15 to 75 years), and 51 (64{\%}) were males. Recurrent coarctation was present in 52 patients (65{\%}), with 6 (8{\%}) having undergone balloon dilatation. Uncontrolled hypertension was present in 63 patients (79{\%}). The most common concomitant pathology was aortic valve stenosis in 21 patients (26{\%}), subaortic stenosis in 10 (13{\%}), and Shone complex in 4 (5{\%}). Results There were no early deaths. The most common concomitant procedures were aortic valve replacement, coronary artery bypass grafting, and resection of subaortic stenosis. The mean aortic cross-clamp and cardiopulmonary bypass times were 33 ± 40 and 106 ± 54 minutes, respectively. Morbidity included atrial fibrillation in 17 patients (21{\%}) and reexploration for bleeding in 6 (8{\%}). There was no paraplegia or stroke. Upper extremity blood pressure significantly improved (p < 0.001). Mean systolic blood pressure decreased from 153 ± 26 mm Hg preoperatively to 123 ± 15 mm Hg postoperatively. Mean follow-up was 7 ± 6 years (maximum, 22 years). Late deaths occurred in 5 patients (6{\%}) and were not graft-related. Three patients (4{\%}) required reoperation for repair of periprosthetic regurgitation in 2 and mitral valve replacement in 1. Conclusions The ascending-to-descending aortic bypass can be performed with low morbidity and mortality. It is an effective solution to complex aortic coarctation and represents a safe single-stage approach for patients with concomitant cardiac pathology.",
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AB - Background Surgical correction of complex aortic coarctation can be associated with significant risks. Extraanatomic bypass may represent a safer alternative. Methods Between January 1985 and December 2012, 80 consecutive patients with complex coarctation underwent ascending-to-descending aortic bypass through a median sternotomy. Patients were a median age of 42 years (range, 15 to 75 years), and 51 (64%) were males. Recurrent coarctation was present in 52 patients (65%), with 6 (8%) having undergone balloon dilatation. Uncontrolled hypertension was present in 63 patients (79%). The most common concomitant pathology was aortic valve stenosis in 21 patients (26%), subaortic stenosis in 10 (13%), and Shone complex in 4 (5%). Results There were no early deaths. The most common concomitant procedures were aortic valve replacement, coronary artery bypass grafting, and resection of subaortic stenosis. The mean aortic cross-clamp and cardiopulmonary bypass times were 33 ± 40 and 106 ± 54 minutes, respectively. Morbidity included atrial fibrillation in 17 patients (21%) and reexploration for bleeding in 6 (8%). There was no paraplegia or stroke. Upper extremity blood pressure significantly improved (p < 0.001). Mean systolic blood pressure decreased from 153 ± 26 mm Hg preoperatively to 123 ± 15 mm Hg postoperatively. Mean follow-up was 7 ± 6 years (maximum, 22 years). Late deaths occurred in 5 patients (6%) and were not graft-related. Three patients (4%) required reoperation for repair of periprosthetic regurgitation in 2 and mitral valve replacement in 1. Conclusions The ascending-to-descending aortic bypass can be performed with low morbidity and mortality. It is an effective solution to complex aortic coarctation and represents a safe single-stage approach for patients with concomitant cardiac pathology.

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