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Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up

Thoracic and Cardiovascular Surgery Department, University of Paris VI Pierre et Marie, Groupe Hospitalier Pitie-Salpêtrière, Assistance Publique – Hôpitaux de Paris, 47-83, Boulevard de l’Hôpital, 75651 Paris Cedex 13, France

Received 13 January 2008; received in revised form 18 June 2008; accepted 19 June 2008.

^_* Corresponding author. Tel.: +33 1 42 16 56 09; fax: +33 1 42 16 56 39. (Email: beltranlevy{at}hotmail.com).

Objective: The surgical treatment of recurrent coarctation in adults supposes a redo left thoracotomy with adhesions and high risk of bleeding and injury of adjacent nerves. The rate of paraplegia in these cases may reach 2.6%. Extra-anatomic aortic bypass avoids these complications. We present our results with ascending-to-abdominal aorta extra-anatomic bypass for recurrent aortic coarctation in adults. Methods: Between September 1979 and November 2006 12 patients underwent ascending-to-abdominal aorta bypass. There were 10 males and 2 females. Mean age was 36.2 ± 11.3 (range 21–57) years old. Mean age at primary repair was 14.3 ± 4.2 years old (range 8–21). Operative technique consisted of performing an ascending-to-abdominal aorta bypass via median sternotomy extended into the epigastrium with a supra-umbilical laparotomy through the mid-line abdominal fascia. Concomitant procedures were performed in six patients: three isolated aortic valve replacements (AVR), two ascending aorta graft replacements and one AVR associated with coronary artery bypass graft (CABG). Results: No postoperative mortality was observed. Mean follow-up time was 10.4 ± 9.3 years (range 0.3–27.8). No patients had any graft-related complication or death and all grafts were patent at the end of the follow-up. One patient developed a dilated myocardiopathy, dying at 14 years of follow-up. Four patients had persistence of arterial hypertension controlled with one drug therapy and five patients were asymptomatic. Conclusions: Ascending-to-abdominal aorta extra-anatomic bypass is a safe, effective and less invasive technique for aortic recoarctation in adults with good results at long-term.

Key Words: Coarctation • Reoperation • Adult