# Intrapericardial Extra-Anatomic Aorto-Aortic Bypass for Aortic Coarctation in Adults

## TL;DR

This paper presents a surgical technique for treating aortic coarctation in adults using an intrapericardial bypass, showing successful outcomes and survival.

## Contribution

The study introduces an effective surgical approach for undiagnosed adult aortic coarctation patients using an intrapericardial extra-anatomic bypass.

## Key findings

- All eight patients survived with no operative mortality.
- One patient required reintervention after 118 months due to aortic stenosis.
- The procedure can be combined with other surgeries like valve replacements.

## Abstract

The preferred treatment for aortic coarctation is direct repair during
childhood. However, some patients reach adulthood without being diagnosed.
For these patients, an extra-anatomic bypass offers an alternative
solution.

To evaluate the surgical outcomes of adult patients with aortic coarctation
treated with an extra-anatomic aorto-aortic bypass.

This retrospective study includes adult patients who underwent an
intrapericardial extra-anatomic bypass using a Dacron® tube from 2013
to 2021 (n=8). Clinical characteristics, surgical outcomes, survival rates,
and the need for reinterventions were assessed up to March 31, 2024.

All patients were male, with an average age of 39.9 ± 10.8 years
(range 23-51). All were hypertensive. Four patients had associated aortic
valve disease, and one had coronary artery disease. The operative risk,
calculated using the European System for Cardiac Operative Risk Evaluation
II score, was 1.65%. Four patients underwent concurrent valve surgeries (two
valve replacements, one David procedure, and one Bentall procedure), and one
had coronary artery surgery. The average pump time was 119 minutes, with
longer times for those undergoing additional procedures (157 vs. 82.5
minutes). There was no operative mortality. The mean follow-up period was
107.1 ± 32 months, during which all patients survived. One patient
required reintervention on the 118th postoperative month due to
aortic stenosis, necessitating valve replacement with a biological
prosthesis.

Intrapericardial extra-anatomic bypass is a viable option for treating aortic
coarctation in adults, demonstrating excellent shortand long-term outcomes.
It can be effectively combined with other surgical procedures.