Aortoaortic bypass: indications, techniques and results.

ABSTRACT

The standard surgical treatment of complex cases of aortic obstructions is difficult and sometimes even hazardous, thus necessitating the use of alternative surgical methods to manage these cases. Between 1986 and 1995, nine such patients underwent ascending aorta to descending/abdominal aorta bypass graft as an alternative procedure at a premier medical institution. There was no hospital death nor any significant morbidity. Preoperative systolic blood pressure in right upper limb ranged from 150 mm Hg to 230 mm Hg (mean 180.5 mm Hg) while postoperative systolic blood pressure in right upper limb ranged from 126 mm Hg to 150 mm Hg (mean 134 mm Hg), thereby showing marked improvement. Preoperative pressure gradient across the aortic obstruction ranged from 50 mm Hg to 120 mm Hg (mean 87.2 mm Hg). It was relieved in all except two patients who had resting gradients of 10 mm Hg and 12 mm Hg respectively. All the patients were relieved of their symptoms. After a mean follow-up of 33.3 months (range 6 to 108 months), all the patients are in New York Heart Association (NYHA) class I with evidence of good distal perfusion. This technique of bypassing the aortic obstruction has the added advantage of avoiding the complications associated with standard technique.