Extra-Anatomical Aortic Bypass and Aortic Valve Replacement in a Patient With Aortic Coarctation and Severe Aortic Insufficiency

The authors present a case of extra-anatomical bypass formation combined with aortic valve replacement in a patient with aortic coarctation and aortic valve insufficiency. 
A 50-year-old female with a history of surgical correction of aortic coarctation at the age of five presented with symptoms of dyspnea on minimal exertion and poorly controlled hypertension. Echocardiography revealed aortic coarctation with a maximum gradient of 100 mmHg, along with severe aortic insufficiency. Computed tomography confirmed recoarctation and identified stage III thoracic kyphosis. 

During the procedure, the descending aorta was isolated retropericardially. A distal end-to-side anastomosis was performed using a 20 mm Dacron graft. The aortic valve was excised, and a 19 mm mechanical St. Jude Medical Hemodynamic Plus (SJM HP) valve was implanted. The aortic graft was routed anterior to the inferior vena cava, and a proximal end-to-side anastomosis was created with the ascending aorta. 

The total surgical time was 300 minutes, including 209 minutes of cardiopulmonary bypass and 115 minutes of aortic cross-clamping. 

References

1. Said SM, Dearani JA, Burkhart HM, Schaff HV. Extra-anatomic Bypass Graft for Recurrent Aortic Arch Obstruction. Operative Techniques in Thoracic and Cardiovascular Surgery. 2012;17(4):261–70. Available from: http://dx.doi.org/10.1053/j.optechstcvs.2012.10.001

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