Successful Ascending Aorta-Abdominal Aorta Bypass Graft through the Left Thoracic Cavity in a Patient with Atypical Coarctation

Obata, Shogo; Mukai, Shogo; Morimoto, Hironobu; Hiraoka, Toshifumi; Uchida, Hiroaki; Yamane, Yasuo

doi:10.3400/avd.cr.13-00039

Cited by 4 publications

(2 citation statements)

References 8 publications

(7 reference statements)

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“…In addition, either the ascending aorta or descending aorta will be selected as the inflow of the bypass graft. There are various reports on the route and method [ 8 – 10 ], and each has advantages and disadvantages. When the ascending aorta is selected as the graft inflow, it is necessary to use a side clamp when anastomosing the ascending aorta or clamping the ascending aorta under a cardiac arrest with the establishment of the cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Descending thoracic aorta–abdominal aortic bypass and bilateral renal arterial blood circulation reconstruction are effective in atypical coarctation of the aorta with heart failure: a case report

Mikami

Kamada

Yano

et al. 2021

J Cardiothorac Surg

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Background There are a lot of reports of the renal failure and heart failure due to coarctation of the aorta. However, there are no case reports in which revascularization dramatically improved left ventricular function in patients with progressive decline in left ventricular function. Herein, we present a rare case in which the left ventricular function was dramatically improved by surgical treatment for progressive left ventricular dysfunction due to atypical coarctation of the aorta. Case presentation A 58-year-old man underwent left axillary artery-bilateral femoral artery bypass at another hospital for atypical coarctation of the aorta due to Takayasu’s arteritis. Approximately 10 years later, he was re-hospitalized for heart failure, and the left ventricular ejection fraction gradually decreased to 28%. Computed tomography showed severe calcification and stenosis at the same site from the peripheral thoracic descending aorta to the lower abdominal aorta of the renal artery, and aortography showed delayed bilateral renal artery blood flow. An increase in plasma renin activity was also observed. Despite the administration of multiple antihypertensive drugs, blood pressure control was insufficient. We decided to perform surgical treatment to improve progressive cardiac dysfunction due to increased afterload and activated plasma renin activity. Descending thoracic aorta-abdominal aorta bypass and revascularization of the bilateral renal arteries via the great saphenous vein grafts were performed. Postoperative blood pressure control was improved, and the dose of antihypertensive drugs could be reduced. Plasma renin activity decreased, and transthoracic echocardiography 1.5 years later showed an improvement in contractility with a left ventricular ejection fraction of 58%. Conclusion In atypical coarctation of the aorta in patients with decreased bilateral renal blood flow, heart failure due to renal hypertension, and progressive decrease in left ventricular contractility, descending thoracic aorta-abdominal aortic bypass and bilateral renal artery recirculation can be extremely effective.

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Section: Discussionmentioning

confidence: 99%

Descending thoracic aorta–abdominal aortic bypass and bilateral renal arterial blood circulation reconstruction are effective in atypical coarctation of the aorta with heart failure: a case report

Mikami

Kamada

Yano

et al. 2021

J Cardiothorac Surg

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“…6,7 Some surgeons have adopted techniques such as ascending aorta-abdominal aorta bypass or ascending aorta-thoracic aorta bypass. 7,8 However, these invasive approaches carry a high risk of postoperative gastrointestinal complications and increased bleeding. We have adopted a repair technique that involves constructing a Y-shaped graft from the ascending aorta to the external iliac arteries while performing repair of the comorbid cardiac lesions to reduce the trauma and risks associated with a staged procedure.…”

Section: Introductionmentioning

confidence: 99%

Ascending Aortoiliac Bypass for One-Stage Repair of Adult Aortic Coarctation With Concomitant Cardiac Lesions

Peng

Qiu

et al. 2021

Vasc Endovascular Surg

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Background To evaluate the efficacy and safety of ascending aortoiliac bypass surgery for one-stage repair of adult coarctation of the aorta (CoA) and concomitant cardiac disease. Methods From March 2012 to October 2018, 51 consecutive CoA patients were treated with ascending aorta to bilateral iliac artery bypass concomitant with and cardiac surgerical procedures performed for a variety of reasons. A Y-shaped graft was used for the bypass procedure. We evaluated early outcomes, including postoperative death, systolic blood pressure and differences between upper and lower limb blood pressure. Results The average age was 41 years and 64.7% of patients were men. Simultaneous cardiac procedures included aortic valve replacement, ventricular septal defect repair, Bentall procedures and Wheat procedures. No deaths occurred in the early postoperative period. Three patients had delayed healing at the site of the abdominal lower quadrant incisions. The average systolic pressure in the upper limb and the average difference between the upper- and lower-limb blood pressure decreased significantly after surgery (162.7 ± 13.4 mmHg vs 128.4 ± 6.7 mmHg, P = .000; 69.6 ± 15.6 mmHg vs 8.7 ± 7.6 mmHg, P = .000, respectively); The systolic blood pressure in the lower limb increased after bypass surgery (93.1 ± 6.2 mmHg vs 119.6 ± 7.7 mmHg, P = .000). The follow-up rate was 100%, with an average follow-up time of 61 months. Six patients (11.8%) had graft stenosis or occlusion. Three patients (5.9%) underwent endovascular embolectomy. Conclusions In our small series, ascending aortoiliac bypass for one-stage repair of CoA with concomitant cardiac lesions appears safe and efficacious in effectively reduceing differences between upper and lower limb systolic blood pressure. Further study with larger sample size and longer follow-up is needed.

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Ascending to Abdominal Aorta Extraanatomic Bypass for Descending Aortic Coarctation: A Reconstruction Technique without Laparotomy or Left Thoracotomy

Terada

Yuasa

Hasegawa

et al. 2014

Annals of Vascular Diseases

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The descending aortic coarctation is often difficult to anatomically reconstruct. We report two cases of ascending aorta to abdominal aorta bypass without laparotomy or thoracotomy. This approach enabled us to avoid anastomosis close to the inflammatory lesion and left thoracotomy causing bleeding from the collateral vessels, and to allow concomitant cardiac procedures to be performed. The graft contact with the intestines can be preventable by the retroperitoneal approach. This technique is useful for the selective patients.

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Successful Ascending Aorta-Abdominal Aorta Bypass Graft through the Left Thoracic Cavity in a Patient with Atypical Coarctation

Cited by 4 publications

References 8 publications

Descending thoracic aorta–abdominal aortic bypass and bilateral renal arterial blood circulation reconstruction are effective in atypical coarctation of the aorta with heart failure: a case report

Descending thoracic aorta–abdominal aortic bypass and bilateral renal arterial blood circulation reconstruction are effective in atypical coarctation of the aorta with heart failure: a case report

Ascending Aortoiliac Bypass for One-Stage Repair of Adult Aortic Coarctation With Concomitant Cardiac Lesions

Ascending to Abdominal Aorta Extraanatomic Bypass for Descending Aortic Coarctation: A Reconstruction Technique without Laparotomy or Left Thoracotomy

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