Surgical Treatment of the Aortic Coarctation in Adults: Extra Anatomical Ascending-to-descending Aortic Bypass and Concomitant Procedures

Objectives: Aortic coarctation is defined as the narrowing of the aortic lumen secondary to hypertrophy of the posterolateral aortic wall’s media layer. The coarctation is locates between the junction from ductus arteriosus to the left subclavian artery and left hemi aortic arch. Aortic coarctation provokes many severe and lethal complications, such as severe aortic stenosis, aortic aneurysms, pseudoaneurysms, stroke, and premature coronary artery disease, unless it had not been repaired in the meantime the initiation of the symptoms. Methods: We presented the consecutive nine patients who underwent aortic coarctation open surgical repair between 2015 and 2020 which initiated ascending-to-descending aortic bypass and then concomitant operations for the secondary cardiac pathology such as ascending aortic aneurysm, Type A aortic dissection and sinus valsalva aneurysm required in some cases. Patients were a median age of 26 years old (range, 19–41 years). About 11% of the patients (n=1) presented to our emergency room with severe chest pain and acute Type 2 aortic dissection was diagnosed by the surgical team, and he underwent operation immediately. The supracoronary aortic replacement and ascending to descending aortic bypass procedures were performed sequentially. About 44% of the patients (n=4) were diagnosed as isolated aortic coarctation and only ascending –to- descending aortic bypass was performed electively. About 22% of the patients (n=2) had ascending aortic aneurysm without aortic valve pathology. These patients underwent supracoronary aortic replacement as concomitant procedure to ascending to descending aortic bypass. About 22% of the patients (n=2) had bicuspid aortic valve and sinus Valsalva aneurysm; therefore, the Bentall procedure was implemented concomitantly. Results: There were not any early deaths reported. Any neurologic complications including neither paraplegia nor stroke revealed during post-operative follow-up. About 88% of patients (n=8) were discharged with stable hemodynamic parameters in 2 weeks. About 11% of these patients (n=1) who underwent Bentall procedure concomitantly had third-degree atrioventricular block as a serious rhythm problem then a permanent pacemaker implanted. This patient had been discharged with stable hemodynamic parameters and pacemaker settings were controlled by the cardiology department. Conclusion: The extra anatomical ascending-to-descending aortic bypass is a safe and feasible method for the open surgical coarctation repair, and it provides concomitant procedures for other cardiac pathologies, which require open surgical treatment.