Ann Short Rep | Volume 1, Issue 5 | Research Article | Open Access
Lakshmi Kumari Sankhyan1, Ujjwal Kumar Chowdhury1*, Niwin George1, Suruchi Hasija2, Priya Jagia3 and Danishwar Meena1
1Departments of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, India
2Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, India
3Department of Cardiac Radiology, All India Institute of Medical Sciences, India
*Correspondance to: Ujjwal Kumar Chowdhury
Fulltext PDFBackground: Use of the supraceliac segment of abdominal aorta for ascending aorta-to-abdominal aorta bypass has been poorly documented for coarctation of aorta and interrupted aortic arch presenting in adults as an alternative to decrease the high complication rate associated with anatomic repair. Patients and
Methods: Between January 1998and September 2018, 16 consecutive patients underwent ascending aorta-to-abdominal aorta bypass in the supraceliac bare area for adult coarctation of aorta and interrupted aortic arch. Age ranged from 18 to 60 years. Indications were coarctation of aorta (n=10), aortic arch interruption (n=3), long segment coarctation of aorta (n=1) and recurrent coarctation of aorta not amenable to endovascular intervention (n=2).
Results: There was no early or late death. There was no spinal cord ischemia, phrenic or left recurrent laryngeal nerve damage, cerebral or coronary steal, chylothorax or massive bleeding. Three patients had paradoxical hypertension, managed conservatively. At a mean follow-up of 10.6 (SD±6.8) years, all patients are in NYHA functional class I and had statistically significant reduction of gradient across the coarctation (p<0.001). Magnetic resonance angiography (n=14) revealed wide, unrestricted anastomoses with no kinking, distortion or anastomotic aneurysms.
Conclusion: On the basis of these results, ascending aorta-to-abdominal aorta bypass in the supraceliac bare area appears to be a versatile technique for relief of coarctation of aorta and interrupted aortic arch presenting in adulthood and eliminates the operative complications associated with anatomical repair. We believe that the absence of mortality and morbidity resulted from careful operative technique and a repair that is well protected deep within the mediastinal space. Long-term evaluation will be mandatory to assess the possible occurrence of specific complications encountered with prosthetic materials.
Adult coarctation of aorta; Interrupted aortic arch; Ascending aorta-to-abdominal aorta bypass; Paradoxical hypertension; Complex coarctation of aorta
Sankhyan LK, Chowdhury UK, George N, Hasija S, Jagia P, Meena D. Ascending-to-Supraceliac Abdominal Aortic Bypass for Complex Coarctation, Recoarctation and Aortic Arch Obstruction in Adults: A 20-Year Postoperative Appraisal. Ann Short Reports. 2018;1:1024.