Off-Pump Repair of Aortic Coarctation and Arch Hypoplasia

This video presents a case involving a six-month-old infant with late presentation of aortic coarctation and small ductus arteriosus. Upon evaluation, aortic arch hypoplasia was also present. Through a median sternotomy, and after thorough mobilization of the ascending aorta and arch vessels, the ductus arteriosus was ligated and divided. 

A temporary shunt was created between the ascending aorta and the innominate artery using a 6 mm Gore-Tex graft, which was sewn to both vessels in an end-to-side fashion. Heparin was administered at a dose of 100 units per kilogram. Once the shunt was completed, temporary clamps were placed on the descending aorta, ascending aorta distal to the shunt, and at the base of the innominate artery proximal to the shunt, in addition to temporary control of the left common carotid and left subclavian arteries. 

The aortic arch was then opened and augmented with a patch of equine pericardium. All clamps were then removed, and the anastomosis was deaired. Equal pressures were observed in the upper and lower extremities’ arterial lines. The temporary shunt was then divided, and its aortic and innominate ends were oversewn. 

The patient tolerated the procedure well with no postoperative issues. The authors believe that this technique may be helpful for some patients, especially those at higher risk of being placed on cardiopulmonary bypass or receiving anticoagulation. 

References

1. Al Halees Z, Abdullah I. Off-pump hypoplastic aortic arch ± aortic coarctation repair via median sternotomy using a temporary shunt. Interact Cardiovasc Thorac Surg 2020 Nov 1;31(5):748-750

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