Treatment of aortic coarctation by axillofemoral bypass grafting in the high-risk patient

Operative correction of coarctation of the aorta has been performed for 45 years. Reoperation for recurrent coarctation is necessary in as many as 5% to 10% of patients. Repair of recurrent coarctation carries an operative mortality of between 5% and 10%. Coarctation repair involves an increased ris...

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Bibliographic Details
Published in:	The Annals of thoracic surgery Vol. 52; no. 6; pp. 1281 - 1284
Main Authors:	Connery, Cliff P., DeWeese, James A., Eisenberg, Barry K., Moss, Arthur J.
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-12-1991 Elsevier Science
Subjects:	Aged Aortic Coarctation - surgery Axillary Artery - surgery Biological and medical sciences Cardiology. Vascular system Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava Female Femoral Artery - surgery Heart Humans Male Medical sciences Middle Aged Recurrence Risk Factors Human Aortic coarctation Axillofemoral Cardiovascular disease Recurrent Concomitant disease Treatment Bypass Follow up study Malformation Heart disease Surgery Aorta Aortic disease
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Summary:	Operative correction of coarctation of the aorta has been performed for 45 years. Reoperation for recurrent coarctation is necessary in as many as 5% to 10% of patients. Repair of recurrent coarctation carries an operative mortality of between 5% and 10%. Coarctation repair involves an increased risk in patients with advanced age, recurrent coarctation, congestive heart failure, and pulmonary disease. We report 3 cases where axillofemoral bypass has been used to treat high-risk patients with aortic coarctation. Two patients had had previous coarctation repair in addition to serious medical problems. Another patient had suffered three myocardial infarctions and had disabling congestive heart failure. All patients had an immediate marked decrease in their preoperative peak systolic pressure gradient across the coarctation. Systemic hypertension and symptoms of congestive heart failure were improved in all patients. The length of follow-up was 15 months, 8.5 years, and 10.5 years. Reassessment with noninvasive vascular segmental pressure studies with and without an exercise component showed no recurrence of the pressure gradient. This procedure should be considered when treating coarctation of the aorta in the high-risk adult.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0003-4975 1552-6259
DOI:	10.1016/0003-4975(91)90013-G