Repair of Coarctation of the Aorta in Adults with Simultaneous Aortic Valve Replacement and Coronary Artery Bypass Grafting

Abstract

The authors present three patients who had either coronary artery disease or severe aortic stenosis or both along with congenital coarction of the aorta. The use of a heterotopic bypass (Dacron tube implanted between the ascending and descending aorta) allowed the surgeons to correct the coarction through a median sternotomy and perform the coronary artery bypass grafting and valve replacement at the same time. The authors are convinced that the scarcely mentioned heterotopic bypassing of the coarcted aorta should be added to the armamentarium of the surgeons who operate on patients with coarctation or recoarctation of the aorta in adulthood or with coarctation that is associated with cardiac lesions.

One-stage treatment of aortic coarctation associated with coronary heart disease, ascending aortic aneurysm, and aortic valve stenosis with an extra-anatomic ascending-descending aortic bypass

“…The treatment through a median sternotomy and repair of the aortic coarctation through the opened aortic arch would have been extremely demanding. 1,2 Therefore, this patient underwent a single-stage procedure through a median sternotomy and total arterial revascularization, mechanical valve replacement, creation of a supracoronary ascending graft, and extra-anatomic ascending-descending bypass. The postoperative magnetic resonance angiography showed a patent ascending-descending bypass (Figure 1) after the approach that is described in this report.…”

“…This bypass ran retrocardially near the right atrium through a pericardial window (behind the phrenic nerve) to the right side of the ascending aorta. 1,2 With the given anatomy in this particular patient, it was easier to obtain control of the anastomotic site at the descending aorta through the opened pleura rather than a pericardial window. After rewarming, the patient was weaned from cardiopulmonary bypass with minimal inotropic support.…”

Posterior Pericardial Ascending-to-Descending Aortic Bypass

“…The 2 surgical approaches for patients with coarctation of the aorta and associated cardiac defects that require repair include a 1-stage simultaneous correction of both lesions through a median sternotomy 4,9,10,14,[17][18][19] and a 2-stage repair through median sternotomy and lateral thoracotomy. 20,21 In 1980, Vijayanagar et al 10 described an adult patient with coarctation of the aorta and severe aortic valve regurgitation.…”

A Review of Surgical and Endovascular Repair of Coarctation of the Aorta

“…Other late complications include stroke, aortic aneurysm, aortic dissection or infective endocarditis. [Turner 2007] In rare cases, patients will present with persistent chest pain, pulmonary edema, atrial fibrillation, LV hypertrophy, and valvular stenosis [22,23].…”