Côme Bosse, Ramzi Ramadan, Rémi Nottin, Dominique Fabre, Olaf Mercier, Philippe Deleuze, Julien Guihaire
Institution : Service de chirurgie cardiaque adultes, centre chirurgical Marie-Lannelongue, Le Plessis-Robinson
Objectives : A subset of patients referred for coronary artery bypass grafting (CABG) or valvular surgery present with sever leg ischemia from Cardiac diseases and aorto-iliac occlusion frequently coexist in the same patients. The ascending aorta has been reported as a being a good source ofgood inflow site for bifemoral bypass.We sought to investigate the post-operative outcomes and long-term patency of this prosthetic ventral aorta when combined with synchronous cardiac surgery combined with ascending aorta to bifemoral bypass.
Methods : Seven patients with a mean age of 64 (47-75), underwent concomitant ventral aorta and of which 6 for CABG (n=6) or and 1 aortic valve replacement (n=1) , underwent surgery through median sternotomy between 2010 and 2016. After weaning from cardiopulmonary bypass, a dacron or PTFE prosthetic tube conduit (Dacron of PTFE, diameter 8 to 16 mm) was sutured to the ascending aorta and led to both femoral arteries, used and either as an Y bifemoral anastomosis graft or as a right femoral anastomosis graft associated with cross-femoral bypass was performed. Long-term graft patency was investigated by physical examination and CT angiogram.
Results : Five (71%) patients were Leriche stage 2B and had a 54% mean left ventricular functionheart function preoperatively. 5 patients underwent the Y bifemoral approach and 2 patients had a right aorto-femoral bypass combined with cross-femoral bypass. No perioperative deaths and no major complications related to the prosthetic ventral aorta occurred. Average length of stay was 12 days (4-19). Mean follow-up was 23 months (1-66). At five years, all grafts were patent except for one distal left branch.
Conclusion : In patients with concomitant cardiac disease and aorto-iliacdiseases chronic occlusion, ascending aorta to bifemoral bypass combined with cardiac surgery is a safe strategy providing favorable outcomes.