Extra-anatomic aortic bypass for treatment of atypical aortic coarctation

MA Shao-hong; WENG Yu-guo; FAN Rui-xin; WU Ruo-bin; ZHENG Shao-yi; ZHOU Cheng-bin; ZHUANG Jian

摘要：Background The conventional extra-anatomic bypass is originated from the axillary's artery and the graft size is often limited due to the small diameter of axillary's artery.Extra-anatomic bypass graft originating from ascending aorta can improve the graft size and distal perfusion,but need sternotomy which might have higher operative risks compared with axillo-femeral bypass.We summarize our experiences of extra-anatomic bypass from ascending aorta for atypical aortic coarctation.Methods Between January 2005 and February 2008,5 women aged from 18 to 64 years underwent extra-anatomic bypass from ascending aorta to abdominal aorta or iliac artery bypass for treatment of atypical aortic coarctation.Preoperatively,all patients had hypertension and needed antihypertensive medications.Systolic blood pressure was 151 ± 9 mmHg.Ankle pressure index (API) were 0.60 ±0.23 in left and 0.56 ± 0.23 in right.Average systolic pressure gradient of aortic stenosis was 76 ± 18 mmHg.Three patients underwent concomitant cardiac operation,including coronary artery bypass grafting,Bentall procedure and atrial septal defect repair.Results There was no hospital and late mortality during 58 ± 15 months follow-up (range from 44 to 81 months).Postoperative systolic blood pressure was reduced to 126 ± 11 mmHg at the time of discharge.All patients maintained normal blood pressure without medication during follow-up.API was improved to 1.12 ± 0.24 in left and 1.17 ± 0.25 in right (compared with preoperative data,P ＜ 0.05).Follow-up computer tomography showed patency in all grafts.Conclusions Surgical treatment of atypical aortic coarctation with extra-anatomic bypass originating from ascending aorta alleviates hypertension and low limb ischemia.