Extraanatomic thoracic aortic bypass grafts: indications, techniques, and results1

Open Access
Publisher Website
Google Scholar
Abstract
OBJECTIVE: Even in the age of extensive aortic replacement specialcircumstances may warrant the insertion of extraanatomic thoracic aorticbypass grafts. Our experience with 17 patients is analyzed. METHODS:Between 1988 and 1994, ten female and seven male patients (mean age 37.5years, range 9-69 years) were treated for the following indications: (1)complex CoA (n = 5); (2) reoperation for CoA (n = 6); (3) extensive aorticocclusive disease (n = 4); and (4) complicated aneurysm (n = 2). Routing ofthe grafts was: ascending-descending aorta (8); ascending-abdominal aorta(4); left subdavian artery- descending aorta (2); descending-descendingaorta (2); and descending-abdominal aorta (1). Eight procedures werereoperations. In four patients concomitant cardiac operations wereperformed: one aortic valve replacement, one patch plasty of the LCA, andtwo composite graft replacements of aortic valve and ascending aorta, oneof them with CABG. RESULTS: Three early deaths occurred. two afteremergency operation in thoracic aneurysm under dire conditions (oneperforation, one infection), one after ascending-abdominal aortic graftingwith multiple branch revascularization. The underlying pathology wasrelieved successfully in all 14 survivors. In the two patients withconcomitant aortic valve and isthmic stenosis, critical anterior motion ofthe mitral valve, presumably because of the massive afterload reduction ofthe left ventricle, complicated the perioperative course. One patient wasreoperated because of aneurysm 4 years after descending- descending aorticgrafting for complex CoA with poststenotic dilatation. CONCLUSIONS: Incomplex aortic coarctation or hypoplasia extraanatomic bypass grafts areexpedient and effective procedures, especially for reoperation. Their usein the treatment of aneurysmal lesions remains an exception.