HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map 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 Author home page(s): Sabine Daebritz Bruno J. Messmer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Daebritz, S. Articles by Messmer, B. J. Search for Related Content PubMed PubMed Citation Articles by Daebritz, S. Articles by Messmer, B. J.

Eur J Cardiothorac Surg 1999;16:519-523
© 1999 Elsevier Science NL

Anatomically positioned aorta ascending-descending bypass grafting via left posterolateral thoracotomy for reoperation of aortic coarctation

^a Department of Thoracic and Cardiovascular Surgery, ‘Klinik für Thorax-, Herz- und Gefäßchirurgie’, Universitätsklinikum der RWTH, Pauwelsstraße 30, 52057 Aachen, Germany
^b Department of Pediatric Cardiology, ‘Kinderkardiologische Klinik’, Universitätsklinikum der RWTH, Pauwelsstraße 30, 52057 Aachen, Germany
^c Department of Internal Medicine I, ‘Medizinische Klinik I’, Universitätsklinikum der RWTH, Pauwelsstraße 30, 52057 Aachen, Germany

Corresponding author. Department of Thoracic and Cardiovascular Surgery, University Hospital, Pauwelsstrasse 30, D-52057 Aachen, Germany. Tel.: +49-241-808-9221; fax: +49-241-888-8454
e-mail: sdaebritz{at}aol.com

Objective: Operation for aortic recoarctation and/or residual hypoplastic arch represents a surgical challenge because of surrounding scar tissue in the coarctation area, hazard of spinal cord ischemia due to aortic cross-clamping, laceration of the recurrent nerve, and the choice of the best approach. We demonstrate the first results of an anatomically guided technique via the prior left thoracotomy approach without establishment of cardiopulmonary bypass. Methods: Since 1989, five patients underwent anatomically positioned ascending-descending bypass grafting for treatment of recoarctation. Indication was a non-dilatable hypoplastic aortic arch segment; in two cases an additional isthmic restenosis was present. Inclusion criteria for our technique was an aorta ascending diameter large enough to allow partial clamping. Primary repair of aortic coarctation was end-to-end anastomosis in four patients and patch angioplasty in one. Mean age at primary repair was 5.5 years and at reoperation 16.1 years. Systolic pressure gradients at rest ranged from 35 to 70 mmHg; upper extremity hypertension was present in all patients. Operative technique consisted of performing a dacron or PTFE aorta ascending-descending bypass graft parallel to the aortic arch, size 18 or 20 mm in diameter, via the prior left thoracotomy. Results: There were no intraoperative complications and all patients survived. Postoperative complications were left lung atelectasis with necessity of reintubation, pericardial effusion, and transient left diaphragm elevation, each in one patient. After 7–90 months all patients are free of symptoms, have normal blood pressure (with two patients being under anti-hypertensive medication), and have no echocardiographically measurable pressure gradients. Conclusions: Anatomically positioned aorta ascending-descending bypass grafting via the prior left posterolateral thoracotomy without cardiopulmonary bypass is a safe and efficient method for operation of complex recoarctation in patients with an acceptable size of the aorta ascendens.

Key Words: Aortic recoarctation • Hypoplastic aortic arch • Posterolateral thoracotomy • Bypass grafting • Surgical treatment

This article has been cited by other articles:

				T. Goto, Y. Tsutsumi, T. Kawai, and H. Ohhashi Total arch replacement of late aneurysm after bypass grafting for coarctation of the aorta Eur. J. Cardiothorac. Surg., July 1, 2007; 32(1): 176 - 177. [Abstract] [Full Text] [PDF]

				V. Arakelyan, A. Spiridonov, and L. Bockeria Ascending-to-descending aortic bypass via right thoracotomy for complex (re-) coarctation and hypoplastic aortic arch Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 815 - 820. [Abstract] [Full Text] [PDF]

				N. Kang, A. J. B. Clarke, I. A. Nicholson, and R. B. Chard Circulatory arrest for repair of postcoarctation site aneurysm Ann. Thorac. Surg., June 1, 2004; 77(6): 2029 - 2033. [Abstract] [Full Text] [PDF]

				P. A. Berdat, V. Gober, and T. Carrel Extra-anatomic aortic bypass for complex (re-) coarctation and hypoplastic aortic arch in adolescents and adults Interactive CardioVascular and Thoracic Surgery, June 1, 2003; 2(2): 133 - 137. [Abstract] [Full Text] [PDF]

				S. Fraund, A. Boning, J. Scheewe, and J. T. Cremer Antero-axillary access for hypoplastic aortic arch repair Ann. Thorac. Surg., January 1, 2002; 73(1): 278 - 280. [Abstract] [Full Text] [PDF]

				C. Manganas, J. Iliopoulos, R. B. Chard, and G. R. Nunn Reoperation and coarctation of the aorta: the need for lifelong surveillance Ann. Thorac. Surg., October 1, 2001; 72(4): 1222 - 1224. [Abstract] [Full Text] [PDF]