Background: Extra-anatomical ascending-descending aortic bypass (EAADAB) is a safe surgical option for the relief of complex coarctation and aortic arch obstruction, but long-term functional outcome is lacking.
Methods: Retrospective analysis of all patients who underwent EAADAB at our institution between 1/1981 and 6/2017.
Results: Twenty-one patients (n=9 females, 8 in child-bearing age), mean age 35.9±10.2 years, were identified. Mean follow-up is 12.1±8.5 years and is complete. Mean age at operation was 23.8 ± 12.3 years. Fourteen patients had undergone previous aortic arch interventions. Two late deaths occurred: one due to HIV, one caused by an intra-cerebral bleeding from an arterio-venous malformation, 16 and 13 years postoperatively. Three patients required re-intervention: two for pseudoaneurysm, one for a stenotic distal anastomosis, 32,13, and 7 years postoperatively respectively. Echocardiography showed left ventricular hypertrophy in 3 patients and diastolic dysfunction (grade I and II) in 6. Upper extremity blood pressure (BP) was lowered significantly: systolic from 157±34mmHg prior to the operation, to 131±15mmHg at last follow-up (p<0.05), diastolic from 81±18mmHg to 72±14mmHg (p<0.05). However, sixteen patients still need antihypertensive medication. All patients perform professional and physical activities without limitations. Patients achieved a mean exercise capacity of 116±34% of the predicted value without ischemic changes or symptoms during cardiopulmonary exercise testing. However, mean maximum BP during peak exercise was 201±40/83±35mmHg, with 12 patients reaching a systolic BP ≥200mmHg. Two patients successfully completed pregnancy and gave birth to 3 normal-sized babies. One patient died of an intra-cerebral bleeding during the 3rd trimester.
Conclusion: EAADAB is a safe and effective surgical option for patients with complex coarctation and/or aortic arch pathology, but requires long-term follow-up. It allows for an excellent exercise capacity without neurological or ischemic complications, but residual arterial hypertension and BP increase on exertion require attention and antihypertensive therapy in most patients. Successful pregnancy can be accomplished under clinical surveillance.