Posterior pericardial ascending-to-descending aortic bypass: An alternative surgical approach for complex coarctation of the aorta

H. M. Connolly, Hartzell V Schaff, U. Izhar, J. A. Dearani, C. A. Warnes, T. A. Orszulak

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Background - Coarctation of the aorta is commonly associated with recoarctation or additional cardiovascular disorders that require intervention. The best surgical approach in such patients is uncertain. Ascending-to-descending aortic bypass graft via the posterior pericardium (CoA bypass) allows simultaneous intracardiac repair or an alternative approach for the patient with complex coarctation. Methods and Results - Between 1985 and 2000, 18 patients (13 males and 5 females, mean age 43±13 years) with coarctation of the aorta underwent CoA bypass through median sternotomy. Before operation, average New York Heart Association class was II (range I to IV), and 15 patients (83%) had systemic hypertension. One or more previous cardiovascular operations had been performed in 12 patients (67%); 10 patients had ≥ 1 prior coarctation repair. Two patients had prior noncoarctation cardiovascular surgery. Concomitant procedures performed in 14 patients (78%) included the following: aortic valve replacement in 9; coronary artery bypass surgery in 3; mitral valve repair in 2; and septal myectomy, mitral valve replacement, aortoplasty, subaortic stenosis resection, ventricular septal defect closure, and ascending aorta replacement in 1 patient each. All patients survived the operation and were alive with patent CoA bypass at a mean follow-up of 45 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia. Systolic blood pressure fell from 159 mm Hg before surgery to 125 mm Hg after surgery. Conclusions - CoA bypass via median sternotomy can be performed with low morbidity and mortality. Although management must be individualized, extra-anatomic CoA bypass via the posterior pericardium is an excellent single-stage approach for patients with complex coarctation or recoarctation and concomitant cardiovascular disorders.

Original languageEnglish (US)
JournalCirculation
Volume104
Issue numberSUPPL. 1
StatePublished - Sep 18 2001

Fingerprint

Aortic Coarctation
Coenzyme A
Sternotomy
Pericardium
Mitral Valve
Blood Pressure
Transplants
Paraplegia
Ventricular Heart Septal Defects
Aortic Valve
Coronary Artery Bypass
Aorta
Pathologic Constriction
Stroke
Hypertension
Morbidity

Keywords

  • Aorta
  • Bypass
  • Coarctation
  • Heart defects, congenital
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Connolly, H. M., Schaff, H. V., Izhar, U., Dearani, J. A., Warnes, C. A., & Orszulak, T. A. (2001). Posterior pericardial ascending-to-descending aortic bypass: An alternative surgical approach for complex coarctation of the aorta. Circulation, 104(SUPPL. 1).

Posterior pericardial ascending-to-descending aortic bypass : An alternative surgical approach for complex coarctation of the aorta. / Connolly, H. M.; Schaff, Hartzell V; Izhar, U.; Dearani, J. A.; Warnes, C. A.; Orszulak, T. A.

In: Circulation, Vol. 104, No. SUPPL. 1, 18.09.2001.

Research output: Contribution to journalArticle

Connolly, H. M. ; Schaff, Hartzell V ; Izhar, U. ; Dearani, J. A. ; Warnes, C. A. ; Orszulak, T. A. / Posterior pericardial ascending-to-descending aortic bypass : An alternative surgical approach for complex coarctation of the aorta. In: Circulation. 2001 ; Vol. 104, No. SUPPL. 1.
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AU - Connolly, H. M.

AU - Schaff, Hartzell V

AU - Izhar, U.

AU - Dearani, J. A.

AU - Warnes, C. A.

AU - Orszulak, T. A.

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N2 - Background - Coarctation of the aorta is commonly associated with recoarctation or additional cardiovascular disorders that require intervention. The best surgical approach in such patients is uncertain. Ascending-to-descending aortic bypass graft via the posterior pericardium (CoA bypass) allows simultaneous intracardiac repair or an alternative approach for the patient with complex coarctation. Methods and Results - Between 1985 and 2000, 18 patients (13 males and 5 females, mean age 43±13 years) with coarctation of the aorta underwent CoA bypass through median sternotomy. Before operation, average New York Heart Association class was II (range I to IV), and 15 patients (83%) had systemic hypertension. One or more previous cardiovascular operations had been performed in 12 patients (67%); 10 patients had ≥ 1 prior coarctation repair. Two patients had prior noncoarctation cardiovascular surgery. Concomitant procedures performed in 14 patients (78%) included the following: aortic valve replacement in 9; coronary artery bypass surgery in 3; mitral valve repair in 2; and septal myectomy, mitral valve replacement, aortoplasty, subaortic stenosis resection, ventricular septal defect closure, and ascending aorta replacement in 1 patient each. All patients survived the operation and were alive with patent CoA bypass at a mean follow-up of 45 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia. Systolic blood pressure fell from 159 mm Hg before surgery to 125 mm Hg after surgery. Conclusions - CoA bypass via median sternotomy can be performed with low morbidity and mortality. Although management must be individualized, extra-anatomic CoA bypass via the posterior pericardium is an excellent single-stage approach for patients with complex coarctation or recoarctation and concomitant cardiovascular disorders.

AB - Background - Coarctation of the aorta is commonly associated with recoarctation or additional cardiovascular disorders that require intervention. The best surgical approach in such patients is uncertain. Ascending-to-descending aortic bypass graft via the posterior pericardium (CoA bypass) allows simultaneous intracardiac repair or an alternative approach for the patient with complex coarctation. Methods and Results - Between 1985 and 2000, 18 patients (13 males and 5 females, mean age 43±13 years) with coarctation of the aorta underwent CoA bypass through median sternotomy. Before operation, average New York Heart Association class was II (range I to IV), and 15 patients (83%) had systemic hypertension. One or more previous cardiovascular operations had been performed in 12 patients (67%); 10 patients had ≥ 1 prior coarctation repair. Two patients had prior noncoarctation cardiovascular surgery. Concomitant procedures performed in 14 patients (78%) included the following: aortic valve replacement in 9; coronary artery bypass surgery in 3; mitral valve repair in 2; and septal myectomy, mitral valve replacement, aortoplasty, subaortic stenosis resection, ventricular septal defect closure, and ascending aorta replacement in 1 patient each. All patients survived the operation and were alive with patent CoA bypass at a mean follow-up of 45 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia. Systolic blood pressure fell from 159 mm Hg before surgery to 125 mm Hg after surgery. Conclusions - CoA bypass via median sternotomy can be performed with low morbidity and mortality. Although management must be individualized, extra-anatomic CoA bypass via the posterior pericardium is an excellent single-stage approach for patients with complex coarctation or recoarctation and concomitant cardiovascular disorders.

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KW - Bypass

KW - Coarctation

KW - Heart defects, congenital

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