PMID- 21476189 OWN - NLM STAT- MEDLINE DCOM- 20120816 LR - 20161125 IS - 1439-1902 (Electronic) IS - 0171-6425 (Linking) VI - 60 IP - 3 DP - 2012 Apr TI - Ascending-to-descending bypass for simultaneous surgery of aortic coarctation with other cardiac pathologies. PG - 210-4 LID - 10.1055/s-0030-1270942 [doi] AB - BACKGROUND: The appropriate approach for aortic coarctation associated with other cardiac diseases necessitating surgery is still controversial. The aim of this study was to evaluate the results after simultaneous surgery performed via median sternotomy and consisting of extra-anatomical ascending-to-descending aortic bypass and various other cardiac procedures. METHODS: Between January 1999 and February 2009, 13 consecutive patients with aortic coarctation coexistent with other cardiac diseases necessitating surgery underwent simultaneous surgery via median sternotomy. An extra-anatomical ascending-to-descending aortic bypass for coarctation repair was performed in all patients accompanied by various cardiac procedures (5 aortic root and valve replacement; 2 aortic valve replacement; 2 coronary artery bypass grafting; 2 mitral valve repair; 1 aortic valve replacement and coronary artery bypass grafting; 1 mitral and tricuspid valve repair). There were 3 women and 10 men with a mean age of 52 years (range 25-69). Two patients had recurrent or residual coarctation 37 and 46 years after previous surgical repair, respectively. RESULTS: Early mortality was 0 and there was only 1 late death during the follow-up of up to 11 years. New York Heart Association (NYHA) functional class improved on average from 2.4 to 1.2. At the last follow-up, blood pressure measured at the upper and lower extremities showed no gradient in any patient, indicating a durable function of the extra-anatomical bypass. Only 3 patients were on reduced antihypertensive therapy; 8 patients were on the same medication and 1 patient required increased medication therapy compared with the medication prior to surgery. CONCLUSIONS: Ascending-to-descending bypass can be performed via median sternotomy simultaneously with various cardiac procedures without considerable extension of the procedure. The operative and long-term results are excellent, and this approach can be recommended as the procedure of choice in patients with aortic coarctation and additional cardiac diseases necessitating surgery. CI - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA. FAU - Reents, W AU - Reents W AD - Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany. FAU - Froehner, S AU - Froehner S FAU - Diegeler, A AU - Diegeler A FAU - Urbanski, P P AU - Urbanski PP LA - eng PT - Journal Article DEP - 20110407 PL - Germany TA - Thorac Cardiovasc Surg JT - The Thoracic and cardiovascular surgeon JID - 7903387 RN - 0 (Antihypertensive Agents) SB - IM MH - Adult MH - Aged MH - Antihypertensive Agents/therapeutic use MH - Aortic Coarctation/complications/diagnostic imaging/mortality/physiopathology/*surgery MH - Aortography/methods MH - *Blood Vessel Prosthesis Implantation/adverse effects/mortality MH - *Cardiac Surgical Procedures/adverse effects/mortality MH - Coronary Artery Bypass MH - Female MH - Germany MH - Heart Diseases/complications/mortality/physiopathology/*surgery MH - Heart Valve Prosthesis Implantation MH - Hemodynamics MH - Humans MH - Hypertension/drug therapy/etiology MH - Male MH - Middle Aged MH - Multidetector Computed Tomography MH - Sternotomy MH - Time Factors MH - Treatment Outcome EDAT- 2011/04/09 06:00 MHDA- 2012/08/17 06:00 CRDT- 2011/04/09 06:00 PHST- 2011/04/09 06:00 [entrez] PHST- 2011/04/09 06:00 [pubmed] PHST- 2012/08/17 06:00 [medline] AID - 10.1055/s-0030-1270942 [doi] PST - ppublish SO - Thorac Cardiovasc Surg. 2012 Apr;60(3):210-4. doi: 10.1055/s-0030-1270942. Epub 2011 Apr 7.