Repair of Recurrent Coarctation Using an Ascending Aortic Autograft

Abstract

Results of aortic arch repair for interrupted aortic arch or aortic coarctation have considerably improved. However, re-stenosis or aneurysm formation is a common complication requiring complex re-interventions or even extra-anatomic bypass grafting. In two patients with recurrent coarctation, the use of cardiopulmonary bypass was mandatory, in one due to the concomitant repair of the intra-cardiac defect, in the other due to the small aortic arch, the long segment aortic coarctation and the small diameter of the supra-aortic vessels. In both patients a segment of the ascending aorta was interposed between the distal aortic arch and the proximal descending aorta with uneventful postoperative courses and freedom from pathological findings at 1 year and 6 months follow-up. In patients undergoing complex congenital heart surgery involving the ascending aorta, a segment of the autologous ascending aorta may be used to repair recurrent isthmic stenosis, avoiding the use of any foreign material.

Key words

Aortic arch - coarctation - repair

References

• 1 Serraf A, Lacour-Gayet F, Robotin M, Bruniaux J, Sousa-Uva M, Roussin R, Planche C. Repair of interrupted aortic arch: a ten-year experience.  J Thorac Cardiovasc Surg. 1996;  12 1150-1160
• 2 Zoghbi J, Serraf A, Mohammadi S, Belli E, Lacour Gayet F, Aupecle B, Losay J, Petit J, Planche C. Is surgical intervention still indicated in recurrent aortic arch obstruction?.  J Thorac Cardiovasc Surg. 2004;  127 203-212
• 3 Jonas R A, Quaegebeur J M, Kirklin J W, Blackstone E H, Daicoff G. Outcomes in patients with interrupted aortic arch and ventricular septal defect. A multi-institutional study. Congenital Heart Surgeons Society.  J Thorac Cardiovasc Surg. 1994;  107 1099-1109
• 4 Kanter K R, Erez E, Williams W H, Tam V KH. Extra-anatomic aortic bypass via sternotomy for complex aortic arch stenosis.  J Thorac Cardiovasc Surg. 2000;  120 885-890
• 5 Carrel T P, Berdat P A, Baumgartner I, Dinkel H P, Schmidli J. Combined surgical and endovascular approach to treat a complex aortic coarctation without extracorporeal circulation.  Ann Thorac Surg. 2004;  78 1462-1465
• 6 Kadner A, Dave H, Bettex D, Valsangiacomo-Buechel E, Turina M I, Pretre R. Anatomic reconstruction of recurrent aortic arch obstruction in children.  Eur J Cardiothorac Surg. 2004;  26 60-65
• 7 Massey R, Shore D F. Surgery for complex coarctation of the aorta.  Int J Cardiol. 2004;  97 67-73
• 8 Siblini G, Rao P S, Nouri S, Ferdman B, Jureidini S B, Wilson A D. Long-term follow-up results of balloon angioplasty of postoperative aortic recoarctation.  Am J Cardiol. 1998;  81 61-67