Simultaneous single-staged surgical management of coarctation of aorta concomitant with intra-cardiac abnormality by extra-anatomic aortic bypass grafting

Abstract

Background

Coarctation of the aorta (CoA) is a congenital condition that often requires intervention, especially when associated with other intracardiac abnormalities. Surgical approaches to treat complex CoA and associated defects vary, with no universally accepted standard approach. This study evaluates the outcomes of a single-stage extra-anatomic bypass from the ascending to the descending thoracic aorta, along with simultaneous correction of associated intracardiac abnormalities in adult patients.

Methods

We conducted a retrospective analysis of 17 adult patients who underwent a single-stage extra-anatomic bypass for complex CoA repair between January 2014 and December 2023. Patients were treated with an ascending to descending thoracic aorta bypass via a right-sided extra-anatomic approach, with simultaneous correction of associated cardiac defects. The primary outcomes measured were perioperative mortality, haemodynamic improvement, and post-operative complications.

Results

The mean age of patients was 35.9 years. The single-stage repair showed a 94.1% survival rate, with significant haemodynamic improvement indicated by a reduction in blood pressure gradient from 49.7 ± 7.4 mmHg pre-operatively to 11.2 ± 3.9 mmHg post-operatively. There were minimal complications, with no evidence of graft failure, kinking, or cerebrovascular incidents during follow-up. One patient experienced acute kidney injury and early mortality. Follow-up of up to 10 years demonstrated durable results with favourable outcomes.

Conclusion

The single-stage extra-anatomic bypass with simultaneous correction of associated cardiac defects is a safe and effective approach for managing complex CoA in adults.