Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans Street, Zayed Tower, Baltimore, MD, 21287, USA.
J Cardiothorac Surg. 2024 Jul 15;19(1):448. doi: 10.1186/s13019-024-02968-5.
Extra-anatomic ascending-to-descending aortic bypass grafts have historically been utilized as a safe and effective solution for repairs of complex coarctation of the aorta. However, reports on reoperation in these patients remain rare. We present a case of an aortic valve replacement and coronary artery bypass grafting in a patient with an extra-anatomic ascending-to-descending aortic bypass graft.
The patient is a 59-year-old male with a complex aortic history, including repair of aortic coarctation with an ascending-to-descending aortic bypass graft 13 years prior, was admitted to the hospital for shortness of breath and chest pain that had developed over the past year. On further workup, he was found to have severe bileaflet aortic valve stenosis, non-ST elevation myocardial infarction, and moderate coronary artery disease. He underwent surgical aortic valve replacement and coronary artery bypass grafting. Given his unique anatomy, cardiopulmonary bypass approach involved separate cannulation of the right axillary and left common femoral arteries with cross-clamp of both the aorta and the extra-anatomic graft. Using this approach, the redo operation was successfully performed.
Reports on reoperation after ascending-to-descending aortic bypass grafting are rare. We describe our approach to cardiopulmonary bypass and reoperation in a patient with an extra-anatomic ascending-to-descending aortic bypass graft.
解剖外升主动脉至降主动脉旁路移植术在治疗复杂主动脉缩窄方面一直是一种安全有效的方法。然而，关于这些患者再次手术的报道仍然很少。我们报告了一例解剖外升主动脉至降主动脉旁路移植术患者行主动脉瓣置换和冠状动脉旁路移植术的病例。
患者为 59 岁男性，有复杂的主动脉病史，包括 13 年前行升主动脉至降主动脉旁路移植术治疗主动脉缩窄，因过去一年出现的呼吸困难和胸痛入院。进一步检查发现他患有严重的二叶式主动脉瓣狭窄、非 ST 段抬高型心肌梗死和中度冠状动脉疾病。他接受了外科主动脉瓣置换和冠状动脉旁路移植术。由于其独特的解剖结构，体外循环方法涉及右腋动脉和左股总动脉的单独插管，并对主动脉和解剖外旁路进行交叉夹闭。使用这种方法，成功地进行了再次手术。
解剖外升主动脉至降主动脉旁路移植术后再次手术的报道很少。我们描述了我们在一例解剖外升主动脉至降主动脉旁路移植术患者中进行体外循环和再次手术的方法。
