Left subclavian-aortic bypass grafting in primary isolated adult coarctation

In the adult patient, bypassing the coarcted segment with a tube graft has been described, among others, as a method of repair in re-do cases and in h igh-risk patients. Since 1992, and owing to its simplicity, it has become o ur elected approach in all adult cases. Twenty-two patients (mean age 22.8 +/- 7.18 years) with isolated aortic coarctation distal to the left subclav ian artery were primarily treated with left subclavian-lower descending tho racic aorta bypass using a Hemashield woven double velour graft. There was no hospital mortality nor major postoperative complications. The patients w ere followed-up for a mean period of 2.36 +/- 1.29 years (range 1-5 years). Systolic blood pressure as well as the pressure gradient across the coarct ed segment dropped significantly from 181.82 +/- 15.7/65.7 +/- 13.3 mmHg to 124 +/- 13.63/7.41 +/- 6.49 mmHg (P = 0.009 and 0.001). Sixteen patients ( 72.6%) were recorded to be symptom-free and normotensive and seven patients (31.8%) did not show any residual pressure gradient when last seen. The po stoperative systolic pressure correlated positively with its preoperative v alue (P = 0.017) as well as with patient age (P = 0.015). Partial correlati on, however, suggested that advanced age upon surgery was the determinant f actor responsible for residual postoperative systemic hypertension (P = 0.0 07). Besides being simple, the procedure is low-risk, permits a significant drop in pressure gradient and improves systolic hypertension through an in termediate follow-up period. (C) 1999 The International Society for Cardiov ascular Surgery. Published by Elsevier Science Ltd. All rights reserved.