Posterior pericardial ascending-to-descending aortic bypass - An alternative surgical approach for complex coarctation of the aorta

Background-Coarctation of the aorta is commonly associated with recoarctati on or additional cardiovascular disorders that require intervention. The be st surgical approach in such patients is uncertain. Ascending-to-descending aortic bypass graft via the posterior pericardium (CoA bypass) allows simu ltaneous intracardiac repair or an alternative approach for the patient wit h complex coarctation. Methods and Results-Between 1985 and 2000, 18 patients (13 males and 5 fema les, mean age 43 +/- 13 years) with coarctation of the aorta underwent CoA bypass through median sternotomy. Before operation, average New York Heart Association class was II (range I to IV), and 15 patients (83%) had systemi c hypertension. One or more previous cardiovascular operations had been per formed in 12 patients (67%); 10 patients had greater than or equal to1 prio r coarctation repair. Two patients had prior noncoarctation cardiovascular surgery. Concomitant procedures performed in 14 patients (78%) included the following: aortic valve replacement in 9; coronary artery bypass surgery i n 3; mitral valve repair in 2; and septal myectomy, mitral valve replacemen t., aortoplasty, subaortic stenosis resection, ventricular septal defect cl osure, and ascending aorta replacement in I patient each. All patients surv ived the operation and were alive with patent CoA bypass at a mean follow-u p of 45 months. No graft-related complications occurred, and there were no instances of stroke or paraplegia. Systolic blood pressure fell from 159 mm Hg before surgery to 125 mm Hg after surgery. Conclusions-CoA bypass via median sternotomy can be performed with low morb idity and mortality. Although management must be individualized. extra-anat omic CoA bypass via the posterior pericardium is an excellent single-stage approach for patients with complex coarctation or recoarctation and concomi tant cardiovascular disorders.