Intrapericardial Extra-Anatomic Aorto-Aortic Bypass for Aortic Coarctation in Adults.

Abstract

Introduction: The preferred treatment for aortic coarctation is direct repair during childhood. However, some patients reach adulthood without being diagnosed. For these patients, an extra-anatomic bypass offers an alternative solution.

Objective: To evaluate the surgical outcomes of adult patients with aortic coarctation treated with an extra-anatomic aorto-aortic bypass.

Methods: This retrospective study includes adult patients who underwent an intrapericardial extra-anatomic bypass using a Dacron® tube from 2013 to 2021 (n=8). Clinical characteristics, surgical outcomes, survival rates, and the need for reinterventions were assessed up to March 31, 2024.

Results: All patients were male, with an average age of 39.9 ± 10.8 years (range 23-51). All were hypertensive. Four patients had associated aortic valve disease, and one had coronary artery disease. The operative risk, calculated using the European System for Cardiac Operative Risk Evaluation II score, was 1.65%. Four patients underwent concurrent valve surgeries (two valve replacements, one David procedure, and one Bentall procedure), and one had coronary artery surgery. The average pump time was 119 minutes, with longer times for those undergoing additional procedures (157 vs. 82.5 minutes). There was no operative mortality. The mean follow-up period was 107.1 ± 32 months, during which all patients survived. One patient required reintervention on the 118th postoperative month due to aortic stenosis, necessitating valve replacement with a biological prosthesis.

Conclusion: Intrapericardial extra-anatomic bypass is a viable option for treating aortic coarctation in adults, demonstrating excellent shortand long-term outcomes. It can be effectively combined with other surgical procedures.