Posterior Pericardial Ascending-to-descending Aortic Bypass for Complex Coarctation or Interrupted Aortic Arch Adult Patients with Coexistent Cardiac Disorder_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LANHuai ¹ ,  CHENXiao-zhong ² , JIABao-cheng ¹ , CHENGYun-ge ¹ , ZHANGHao ² , FANShi-hao ² , GUOYue-jie ² , LIXiang ¹

1. Department of Thoracoscopic Cardiac Center, Shanghai Yodak Cardiothoracic Hospital, Shanghai 200235, P.R.China;
2. Department of Adult Cardiac Surgery, Shanghai Yodak Cardiothoracic Hospital, Shanghai 200235, P.R.China;

Corresponding author：

CHENXiao-zhong, Email: xiaozchen@hotmail.com

Keywords：

Congenital heart disease; Aortic coarctation; Interrupted aortic arch; Bypass; Surgery

DOI：

10.7507/1007-4848.20160086

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Objective To explore of a surgical approach of posterior pericardial ascending-to-descending aortic bypass through a median sternotomy for complex coarctation and interrupted aortic arch adult patients with coexistent cardiac disorder. Methods We retrospectively reviewed the clinical data of 2 adult patients with complex coarctation and 1 adult patient with interrupted aortic arch and all with coexistent cardiac disorder who underwent ascending-to-descending aortic bypass in our hospital between April 2010 and January 2015. There were 2 males and 1 female with age of 35.6 (27-46) years. One patient was with complex coarctation, and prolapse of anterior mitral leaflet with moderate regurgitation. One patient was with complex coarctation, and bicuspid aortic valve with severe aortic regurgitation, and ascending aortic aneurysm. One patient was with interrupted aortic arch (type A), and bicuspid aortic valve with mild stenosis, and secundum atrial septal defect. The surgical approach used in all patients was the median sternotomy. After aorta, femoral artery and bicaval cannulation, hypothermic cardiopulmonary bypass was established. With posterior pericardial ascending-to-descending aortic bypass procedure for repair of complex coarctation and interrupted aortic arch with coexistent cardiac disorder. Results There was no death. The symptoms of the patients obviously improved. All the patients were alive with ascending-to-descending aortic bypass procedure at a mean follow-up ranged from 2 to 59 months. Except that one patient had residual upper-extremity hypertension, and needed antihypertensive medications taken postoperatively, other patients’ systolic blood pressure returned to normal level. All patients’ lower-extremity fatigability resolved. Postoperative computed tomography angiography (CTA) of the patients showed that dacron graft was unobstructed with no graft-related complications of kinking and narrowing, development of false aneurysms or other complications. Conclusion The surgical management of adult patients’ complex coarctation and interrupted aortic arch with coexistent cardiac disorder, a one-stage approach using pericardial ascending-to-descending aortic bypass through a median sternotomy is an alternative surgery.

Citation： LANHuai, CHENXiao-zhong, JIABao-cheng, CHENGYun-ge, ZHANGHao, FANShi-hao, GUOYue-jie, LIXiang. Posterior Pericardial Ascending-to-descending Aortic Bypass for Complex Coarctation or Interrupted Aortic Arch Adult Patients with Coexistent Cardiac Disorder. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 373-376. doi: 10.7507/1007-4848.20160086 Copy

1.	Becker AE, Becker MJ, Edwards JE. Anomalies associated with coarctation of the aorta. Particular references to infancy. Circulation,1970, 41(6): 1067-1075.
2.	Jonas RA, Quaegebeur JM, Kirklin JW, et al. Outcomes in patients with interrupted aortic arch and ventricular septal defect. J Thorac Cardiovasc Surg, 1994, 107(4): 1099-1109.
3.	Connolly HM, Schaff HV, Izhar U, et al. Posterior pericardial ascending-to descending aortic bypass: an alternative surgical approach for complex coarctation of the aorta. Circulation, 2001, 104 (12 Suppl 1): 133-137.
4.	McKellar SH, Schaff HV, Dearani JA, et al. Intermediate-term results of ascending-descending posterior pericardial bypass of complex aortic coarctation. J Thorac Cardiovasc Surg, 2007, 133(6): 1504-1509.
5.	Burkhart HM, Dearani JA, Connolly HM, et al. Ascending-descen-ding posterior bypass of complex coarctation of the aorta. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann, 2011, 14 (1): 116-119.
6.	Brown ML, Burkhart HM, Connolly HM, et al. Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation, 2010, 122 (11 Suppl): S81-S84.
7.	Foster E. Reoperation for aortic coarctation. Ann Thorac Surg, 1984, 38: 81-89.
8.	Sweeney M, Walker W, Duncan J, et al. Reoperation for aortic coarctation: techniques, results, and indications for various approaches. Ann Thorac Surg, 1985, 40(1): 46-49.
9.	Vijayanagar R, Natarajan P, Eckstein P, et al. Aortic valvular insufficiency and postductal aortic coarctation in the adult: combined surgical management through median sternotomy: a new surgical approach. J Thorac Cardiovasc Surg, 1980, 79(2): 266-268.
10.	Powell W, Adams P, Cooley D. Repair of coarctation of the aorta with intracardiac repair. Tex Heart Inst J, 1983, 10(4): 409-413.
11.	Heinemann MK, Ziemer G, Wahlers T, et al. Extraanatomic thoracic aortic bypass grafts: indications, techniques, and results. Eur J Cardiothorac Surg, 1997, 11(1): 169-175.
12.	Grinda J, Mace L, Dervanian P, et al. Bypass graft for complex forms of isthmic aortic coarctation in adults. Ann Thorac Surg, 1995, 60(5): 1299-1302.
13.	Moms RJ, Samuels LE, Broekman SK, et al. Total simultaneous repair of coarctation and intracardiac pathlology in adult patients. Ann Thorac Surg, 1998, 65(5): 1698-1702.

1. Becker AE, Becker MJ, Edwards JE. Anomalies associated with coarctation of the aorta. Particular references to infancy. Circulation,1970, 41(6): 1067-1075.
2. Jonas RA, Quaegebeur JM, Kirklin JW, et al. Outcomes in patients with interrupted aortic arch and ventricular septal defect. J Thorac Cardiovasc Surg, 1994, 107(4): 1099-1109.
3. Connolly HM, Schaff HV, Izhar U, et al. Posterior pericardial ascending-to descending aortic bypass: an alternative surgical approach for complex coarctation of the aorta. Circulation, 2001, 104 (12 Suppl 1): 133-137.
4. McKellar SH, Schaff HV, Dearani JA, et al. Intermediate-term results of ascending-descending posterior pericardial bypass of complex aortic coarctation. J Thorac Cardiovasc Surg, 2007, 133(6): 1504-1509.
5. Burkhart HM, Dearani JA, Connolly HM, et al. Ascending-descen-ding posterior bypass of complex coarctation of the aorta. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann, 2011, 14 (1): 116-119.
6. Brown ML, Burkhart HM, Connolly HM, et al. Late outcomes of reintervention on the descending aorta after repair of aortic coarctation. Circulation, 2010, 122 (11 Suppl): S81-S84.
7. Foster E. Reoperation for aortic coarctation. Ann Thorac Surg, 1984, 38: 81-89.
8. Sweeney M, Walker W, Duncan J, et al. Reoperation for aortic coarctation: techniques, results, and indications for various approaches. Ann Thorac Surg, 1985, 40(1): 46-49.
9. Vijayanagar R, Natarajan P, Eckstein P, et al. Aortic valvular insufficiency and postductal aortic coarctation in the adult: combined surgical management through median sternotomy: a new surgical approach. J Thorac Cardiovasc Surg, 1980, 79(2): 266-268.
10. Powell W, Adams P, Cooley D. Repair of coarctation of the aorta with intracardiac repair. Tex Heart Inst J, 1983, 10(4): 409-413.
11. Heinemann MK, Ziemer G, Wahlers T, et al. Extraanatomic thoracic aortic bypass grafts: indications, techniques, and results. Eur J Cardiothorac Surg, 1997, 11(1): 169-175.
12. Grinda J, Mace L, Dervanian P, et al. Bypass graft for complex forms of isthmic aortic coarctation in adults. Ann Thorac Surg, 1995, 60(5): 1299-1302.
13. Moms RJ, Samuels LE, Broekman SK, et al. Total simultaneous repair of coarctation and intracardiac pathlology in adult patients. Ann Thorac Surg, 1998, 65(5): 1698-1702.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Posterior Pericardial Ascending-to-descending Aortic Bypass for Complex Coarctation or Interrupted Aortic Arch Adult Patients with Coexistent Cardiac Disorder

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