Document Detail


Off-pump extraanatomic aortic bypass for the treatment of complex aortic coarctation and hypoplastic aortic arch.
MedLine Citation:
PMID:  18222243     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Despite advances in surgical and interventional techniques, the optimal surgical treatment of severe aortic (re) coarctation and hypoplastic aortic arch is still controversial. Anatomic repair may require extensive dissection, cardiopulmonary bypass, and deep hypothermic circulatory arrest with their inherent risks. The aim of this study was to analyze the outcome of off-pump extraanatomic aortic bypass as a surgical alternative to local repair. METHODS: From February 2000 to December 2005, ten consecutive patients (median age 20 years; range, 11 to 38 years) with severe aortic (re) coarctation (n = 4) and (or) hypoplastic aortic arch (n = 7) underwent off-pump extraanatomic aortic bypass through median sternotomy. All but three patients had undergone previous surgery for coarctation and angioplasty or stenting. Three patients underwent concomitant replacement of the ascending aorta because of an aneurysm using cardiopulmonary bypass. RESULTS: Postoperative hospital course was uneventful in all patients. There was no perioperative mortality or significant morbidity. During a mean follow-up of 48 +/- 22 months no patient required additional procedures. All patients were free of symptoms; no patient showed signs of heart failure after follow-up. At last follow-up, no patient presented with claudication, nor any patient experienced orthostatic problems due to a steal phenomenon. During follow-up, hypertension resolved in all patients with residual mild hypertension in two patients. CONCLUSIONS: Off-pump extraanatomic aortic bypass is an attractive treatment option for complex aortic (re) coarctation and hypoplastic aortic arch. Perioperative risks are minimized, hypertension is influenced favorably, and midterm survival is event-free.
Authors:
Florian S Schoenhoff; Pascal A Berdat; Mladen Pavlovic; Alexander Kadner; Markus Schwerzmann; Jean-Pierre Pfammatter; Thierry P Carrel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  85     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-28     Completed Date:  2008-03-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  460-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, University of Berne, Berne, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Anastomosis, Surgical
Aortic Arch Syndromes / mortality,  surgery*,  ultrasonography
Aortic Coarctation / mortality,  surgery*,  ultrasonography
Blood Vessel Prosthesis Implantation*
Cardiopulmonary Bypass / methods
Cardiovascular Surgical Procedures / methods*
Child
Cohort Studies
Echocardiography, Doppler
Female
Follow-Up Studies
Heart Defects, Congenital / mortality,  surgery,  ultrasonography
Humans
Magnetic Resonance Angiography
Male
Postoperative Care
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome
Comments/Corrections
Comment In:
Ann Thorac Surg. 2008 Feb;85(2):464   [PMID:  18222244 ]

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