Mid- to long-term outcomes of median sternotomy ascending-descending thoracic aortic bypass grafting for complex aortic coarctation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIN Yongqiang , FAN Lixin , ZHANG Enrui , ZHANG Xiaoya , XUE Hui , XU Zhonghua ,  WU Qingyu

Heart Center, First Hospital of Tsinghua University, Beijing, 100016, P. R. China;

Corresponding author：

WU Qingyu, Email: wuqingyu@mail.tsinghua.edu.cn

Keywords：

Ascending-descending thoracic aortic bypass grafting; coarctation of aorta; median sternotomy; mid- to long-term outcomes

DOI：

10.7507/1007-4848.202407044

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Objective To investigate the mid- to long-term follow-up results of ascending aorta (AAO)-descending thoracic aorta (DTA) bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation. Methods A retrospective analysis was conducted on the clinical data of patients with complex aortic arch coarctation who underwent AAO-DTA bypass grafting via median sternotomy incision at the First Affiliated Hospital of Tsinghua University from August 2004 to May 2017. Results A total of 7 patients were enrolled, including 4 males and 3 females, aged (13.3±4.6) years, and weighted (40.2±12.2) kg. Six (85.7%) patients had concomitant upper limb hypertension. Four patients were aortic arch coarctation combined with intracardiac malformations, two were post-operative restenosis, and 1 was post-operative restenosis combined with intracardiac malformation. All patients underwent surgery under cardiopulmonary bypass. There were no perioperative deaths or major complications. The pre-operative upper-lower limb pressure difference was (51.4±13.5) mm Hg, which decreased to (2.9±2.7) mm Hg post-operatively (P<0.01). The follow-up period was (14.9±5.9) years. There were no long-term deaths or artificial graft-related complications. Except for one patient who still had mild hypertension, the blood pressure of the remaining patients returned to normal. Conclusion AAO-DTA bypass grafting via median sternotomy incision for the treatment of complex aortic arch coarctation can effectively reduce upper limb blood pressure and the upper-lower limb arterial pressure difference, has fewer complications, and demonstrates satisfactory mid- to long-term efficacy.

1.	Singh S, Hakim FA, Sharma A, et al. Hypoplasia, pseudocoarctation and coarctation of the aorta: A systematic review. Heart Lung Circ, 2015, 24(2): 110-118.
2.	Kreuzer M, Sames-Dolzer E, Klapper M, et al. The anatomic repair of recurrent aortic arch obstruction in children and adolescents. JTCVS Open, 2024, 19: 215-222.
3.	Edie RN, Janani J, Attai LA, et al. Bypass grafts for recurrent or complex coarctations of the aorta. Ann Thorac Surg, 1975, 20(5): 558-566.
4.	Aboulhosn J, Child JS. Left ventricular outflow obstruction: Subaortic stenosis, bicuspid aortic valve, supravalvar aortic stenosis, and coarctation of the aorta. Circulation, 2006, 114(22): 2412-2422.
5.	Jenkins NP, Ward C. Coarctation of the aorta: Natural history and outcome after surgical treatment. QJM, 1999, 92(7): 365-371.
6.	Campbell M. Natural history of coarctation of the aorta. Br Heart J, 1970, 32(5): 633-640.
7.	Foster ED. Reoperation for aortic coarctation. Ann Thorac Surg, 1984, 38(1): 81-89.
8.	Sweeney MS, Walker WE, Duncan JM, et al. Reoperation for aortic coarctation: Techniques, results, and indications for various approaches. Ann Thorac Surg, 1985, 40(1): 46-49.
9.	Izhar U, Schaff HV, Mullany CJ, et al. Posterior pericardial approach for ascending aorta-to-descending aorta bypass through a median sternotomy. Ann Thorac Surg, 2000, 70(1): 31-37.
10.	Wu Q, Chen X, Li H, et al. Ascending-to-descending aortic bypass via posterior pericardium for complex coarctation of aorta. J Card Surg, 2009, 24(2): 167-169.
11.	Wukasch DC, Cooley DA, Sandiford FM, et al. Ascending aorta-abdominal aorta bypass: Indications, technique, and report of 12 patients. Ann Thorac Surg, 1977, 23(5): 442-448.
12.	胡晓鹏, 于存涛, 钱向阳, 等. 正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形. 中国胸心血管外科临床杂志, 2009, 16(4): 270-273.Hu XP, Yu CT, Qian XY, et al. Extra-anatomic aortic bypass grafting through median sternotomy for one-stage treatment of aortic coarctation and associated cardiac diseases. Chin J Clin Thorac Cardiovasc Surg, 2009, 16(4): 270-273.
13.	Jasper A, Harshe G, Keshava SN, et al. Evaluation of normal abdominal aortic diameters in the Indian population using computed tomography. J Postgrad Med, 2014, 60(1): 57-60.
14.	Kumar MV, Choudhary SK, Talwar S, et al. Extraanatomic bypass to supraceliac abdominal aorta for complex thoracic aortic obstruction. Ann Thorac Surg, 2016, 101(4): 1552-1557.
15.	Cho S, Lee CH, Kim ER, et al. Outcomes of aortic coarctation surgical repair in adolescents and adults. Interact Cardiovasc Thorac Surg, 2020, 30(6): 925-931.
16.	Canniffe C, Ou P, Walsh K, et al. Hypertension after repair of aortic coarctation: A systematic review. Int J Cardiol, 2013, 167(6): 2456-2461.
17.	Brown ML, Burkhart HM, Connolly HM, et al. Coarctation of the aorta: Lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol, 2013, 62(11): 1020-1025.
18.	Said SM, Burkhart HM, Dearani JA, et al. Ascending-to-descending aortic bypass: A simple solution to a complex problem. Ann Thorac Surg, 2014, 97(6): 2041-2047.
19.	Grinda JM, Macé L, Dervanian P, et al. Bypass graft for complex forms of isthmic aortic coarctation in adults. Ann Thorac Surg, 1995, 60(5): 1299-1302.
20.	Berdat PA, Göber V, Carrel T. Extra-anatomic aortic bypass for complex (re-) coarctation and hypoplastic aortic arch in adolescents and adults. Interact Cardiovasc Thorac Surg, 2003, 2(2): 133-137.
21.	Al-Husayni F, Samman A, Althobaiti M, et al. Late complications after previous surgical repair for coarctation with extra-anatomic bypass graft: Report on two cases. Cureus, 2021, 13(1): e12722.

1. Singh S, Hakim FA, Sharma A, et al. Hypoplasia, pseudocoarctation and coarctation of the aorta: A systematic review. Heart Lung Circ, 2015, 24(2): 110-118.
2. Kreuzer M, Sames-Dolzer E, Klapper M, et al. The anatomic repair of recurrent aortic arch obstruction in children and adolescents. JTCVS Open, 2024, 19: 215-222.
3. Edie RN, Janani J, Attai LA, et al. Bypass grafts for recurrent or complex coarctations of the aorta. Ann Thorac Surg, 1975, 20(5): 558-566.
4. Aboulhosn J, Child JS. Left ventricular outflow obstruction: Subaortic stenosis, bicuspid aortic valve, supravalvar aortic stenosis, and coarctation of the aorta. Circulation, 2006, 114(22): 2412-2422.
5. Jenkins NP, Ward C. Coarctation of the aorta: Natural history and outcome after surgical treatment. QJM, 1999, 92(7): 365-371.
6. Campbell M. Natural history of coarctation of the aorta. Br Heart J, 1970, 32(5): 633-640.
7. Foster ED. Reoperation for aortic coarctation. Ann Thorac Surg, 1984, 38(1): 81-89.
8. Sweeney MS, Walker WE, Duncan JM, et al. Reoperation for aortic coarctation: Techniques, results, and indications for various approaches. Ann Thorac Surg, 1985, 40(1): 46-49.
9. Izhar U, Schaff HV, Mullany CJ, et al. Posterior pericardial approach for ascending aorta-to-descending aorta bypass through a median sternotomy. Ann Thorac Surg, 2000, 70(1): 31-37.
10. Wu Q, Chen X, Li H, et al. Ascending-to-descending aortic bypass via posterior pericardium for complex coarctation of aorta. J Card Surg, 2009, 24(2): 167-169.
11. Wukasch DC, Cooley DA, Sandiford FM, et al. Ascending aorta-abdominal aorta bypass: Indications, technique, and report of 12 patients. Ann Thorac Surg, 1977, 23(5): 442-448.
12. 胡晓鹏, 于存涛, 钱向阳, 等. 正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形. 中国胸心血管外科临床杂志, 2009, 16(4): 270-273.Hu XP, Yu CT, Qian XY, et al. Extra-anatomic aortic bypass grafting through median sternotomy for one-stage treatment of aortic coarctation and associated cardiac diseases. Chin J Clin Thorac Cardiovasc Surg, 2009, 16(4): 270-273.
13. Jasper A, Harshe G, Keshava SN, et al. Evaluation of normal abdominal aortic diameters in the Indian population using computed tomography. J Postgrad Med, 2014, 60(1): 57-60.
14. Kumar MV, Choudhary SK, Talwar S, et al. Extraanatomic bypass to supraceliac abdominal aorta for complex thoracic aortic obstruction. Ann Thorac Surg, 2016, 101(4): 1552-1557.
15. Cho S, Lee CH, Kim ER, et al. Outcomes of aortic coarctation surgical repair in adolescents and adults. Interact Cardiovasc Thorac Surg, 2020, 30(6): 925-931.
16. Canniffe C, Ou P, Walsh K, et al. Hypertension after repair of aortic coarctation: A systematic review. Int J Cardiol, 2013, 167(6): 2456-2461.
17. Brown ML, Burkhart HM, Connolly HM, et al. Coarctation of the aorta: Lifelong surveillance is mandatory following surgical repair. J Am Coll Cardiol, 2013, 62(11): 1020-1025.
18. Said SM, Burkhart HM, Dearani JA, et al. Ascending-to-descending aortic bypass: A simple solution to a complex problem. Ann Thorac Surg, 2014, 97(6): 2041-2047.
19. Grinda JM, Macé L, Dervanian P, et al. Bypass graft for complex forms of isthmic aortic coarctation in adults. Ann Thorac Surg, 1995, 60(5): 1299-1302.
20. Berdat PA, Göber V, Carrel T. Extra-anatomic aortic bypass for complex (re-) coarctation and hypoplastic aortic arch in adolescents and adults. Interact Cardiovasc Thorac Surg, 2003, 2(2): 133-137.
21. Al-Husayni F, Samman A, Althobaiti M, et al. Late complications after previous surgical repair for coarctation with extra-anatomic bypass graft: Report on two cases. Cureus, 2021, 13(1): e12722.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesMid- to long-term outcomes of median sternotomy ascending-descending thoracic aortic bypass grafting for complex aortic coarctation

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