Thorac Cardiovasc Surg 2013; 61 - OP28
DOI: 10.1055/s-0032-1332267

Extraanatomic bypass for the treatment of midaortic syndrome in children

E Delmo Walter 1, D Absi 1, R Hetzer 1
  • 1Deutsches Herzzentrum Berlin, Cardiovascular and Thoracic Surgery, Berlin, Germany

Purpose: This report aims to introduce the extraanatomic bypass technique to treat the midaortic syndrome and to document its long-term effectiveness.

Methods: Thirteen patients (mean age 6.7, range 8 months -11, years), were diagnosed to have midaortic syndrome, characterized by severe narrowing of the abdominal aorta with involvement of the renal and visceral branches. CT angiography showed variable length of high-grade midaortic stenosis with seven having visceral artery involvement, and nine having renal artery involvement. All children were hypertensive (mean blood pressure: 165 mmHg). Three have had previous nephrectomies. Six patients had a previous percutaneous transluminal renal artery angioplasty. All patients underwent extraanatomic bypass by a left thoracoabdominal approach in 2 and a median sternotomy and transabdominal approach in 11. The aortic obstruction was relieved by ascending aorta-abdominal bypass using Goretex prosthesis in 3 and a woven Dacron graft in 10, anastomosed distal to the narrowing of the abdominal aorta infrarenally, and proximally to the ascending aorta via a diaphragmmatic tunnel. No visceral artery revascularization was done.

Results: Perioperative course was unremarkable. There was a dramatic reduction in blood pressure in all and relief of intermittent claudication in 6 affected patients. One patient had renal artery reimplantation two weeks postoperatively because of recurrence of renal hypertension. At a mean follow-up of 5.8 years (range 9 months-12 years), there was no reoperation nor mortality. Eleven had complete relief of hypertension, and two had mild hypertension. All patients have normal renal function and there were no signs/symptoms of visceral artery malperfusion. Growth and development proceeded normally. Follow-up MRT showed patent grafts without any strictures.

Conclusions: Extraanatomic bypass provides a very effective and long-term relief of hypertension and any malperfusion in midaortic syndrome.