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Case Reports
. 2024 Jul 15;19(1):448.
doi: 10.1186/s13019-024-02968-5.

Reoperative approach after extra-anatomic ascending-to-descending aortic bypass graft

Alice L Zhou  1 , Deven Patel  1 , Michael P Robich  2
Affiliations
Case Reports

Reoperative approach after extra-anatomic ascending-to-descending aortic bypass graft

Alice L Zhou et al. J Cardiothorac Surg. .

Abstract

Background: 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.

Case presentation: 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.

Conclusions: 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.

Keywords: Ascending-to-descending aortic graft; Cardiopulmonary bypass; Extra-anatomic aortic graft; Reoperation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
3D reconstruction images of extra-anatomic aortic bypass graft (white arrow). (A) Sagittal view demonstrating extra-anatomic aortic bypass graft. (B) Sagittal view demonstrating proximity of extra-anatomic aortic bypass graft to sternum. (C) Superior view of extra-anatomic aortic bypass graft
Fig. 2
Fig. 2
Axial computed tomography image of extra-anatomic aortic bypass sitting behind the posterior sternum
Fig. 3
Fig. 3
Schematic demonstrating placement of saphenous vein grafts relative to extra-anatomic ascending-to-descending aortic bypass graft
Fig. 4
Fig. 4
Post-operative coronal computed tomography image of extra-anatomic aortic bypass, saphenous vein grafts, and mechanical aortic valve replacement
See this image and copyright information in PMC

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