Ascending-to-descending aortic bypass via right thoracotomy for complex (re-) coarctation and hypoplastic aortic arch.

OBJECTIVE: Operation for aortic recoarctation and/or residual hypoplastic arch represents a surgical challenge because of surrounding scar tissue in the coarctation area, hazard of spinal cord ischemia due to aortic cross-clamping, laceration of the recurrent nerve, and the choice of the best approach. We demonstrate the results of 52 operations of an extra anatomically bypass technique via right thoracotomy approach without establishment of cardiopulmonary bypass. METHODS: Since 1987, 52 patients underwent extra anatomically positioned ascending-descending bypass grafting. Indication was aortic recoarctation with concomitant hypoplastic aortic arch (45 patients), atypical coarctation of aortic arch (2 patients), congenital anomalies of aortic arch (2 patients) and concomitant aortic coarctation and associated cardiac problems that required surgical repair (2 patient), infected stent-graft of descending aorta (1 patient). Mean age was 19.3 years. Systolic pressure gradients at rest ranged from 35 to 90mmHg; upper extremity hypertension was present in all patients. Operative technique consisted of performing aorta ascending-descending bypass graft size 16 or 18mm in diameter, via right thoracotomy (in 51 patient) or sternotomy (in 1 patient). RESULTS: The mortality rate was 1.9% (1/52). Five patients returned to the operating room (in 3-5 days after operation) for a lymphorrhea complication. An arterial pressure gradient in the limbs was totally corrected. During a follow-up period of actually 79+/-54 months, no adverse event was noticed and antihypertensive medication was stopped in all patients. CONCLUSIONS: Ascending-to-descending aortic bypass via right thoracotomy is a safe and effective method for management complex (re-) coarctation and hypoplastic aortic arch.