Extra-anatomic thoracic aortic bypass operations

Arūnas Valaika, Gediminas Norkūnas, Gintaras Kalinauskas, Giedrė Nogienė, Jurgis Verižnikovas¹, Giedrius Uždavinys, Vytautas Sirvydis

Heart Surgery Center, Vilnius University, ¹Heart Surgery Center, Santariškių Clinics of Vilnius University Hospital, Lithuania

Key words: aortic aneurysm; aortic recoarctation; extra-anatomic thoracic aortic bypass.

Summary. Objective. When the patient condition contraindicates major surgery for descending thoracic aneurysms, the surgeon should consider using an ascending aorta to abdominal aorta bypass graft, leaving the diseased segment undisturbed. Our experience with eight patients is presented.

Material and methods. Between 1988 and 2008, eight patients were treated for the following indications: reoperation for coarctation (two patients), complicated descending aortic aneurysms (five patients), and posttraumatic descending aorta dissection (one patient). The mean age of the patients was 44±8 years (range, 27–53 years). There were 6 (75%) males and 2 (25%) females. Emergency operations were performed in three patients (two with aortic recoarctation, one with posttraumatic aortic dissection). Two cases were reoperations (both after recoarctation). Descending aorta was ligated in seven cases. Distal anastomosis was connected with abdominal aorta in four cases and with iliac arteries in four patients.

Results. Three early deaths occurred. Two patients died after emergency operation after recoarctation and posttraumatic aortic dissection, and one patient died after descending aorta aneurysm correction because of bleeding.

Conclusions. In complex aortic coarctation, extra-anatomic bypass operation remains an effective procedure. The usage of these procedures in patients with descending aortic aneurysms remains complicated.

Correspondence to A. Valaika, Heart Surgery Center, Vilnius University, Santariškių 2, 08661 Vilnius, Lithuania. E-mail: arunas.valaika@santa.lt

Received 29 February 2008, accepted 10 May 2008