Intermediate-term results of ascending-descending posterior pericardial bypass of complex aortic coarctation

Objective: Extra-anatomic bypass of complex thoracic aortic disease through a median sternotomy has been reported as a safe alternative to thoracotomy. Our objective was to examine intermediate-term outcomes. Methods: We retrospectively reviewed 50 consecutive patients with congenital aortic coarctation or recurrent coarctation who underwent ascending-descending posterior pericardial aortic bypass between January 1985 and November 2005. Demographic data, in-hospital and postoperative morbidity and mortality, and resolution of hypertension were determined by examination of the medical record. Results: The mean age at operation was 42 years; 27 (54%) were men. There were no perioperative deaths. Upper-extremity blood pressure after coarctation repair with ascending-descending aortic bypass was significantly improved. Mean systolic blood pressure decreased from 158 ± 25 mm Hg preoperatively to 123 ± 14 mm Hg postoperatively (P < .001). There were no graft-related deaths or complications in follow-up extending up to 20 years. Conclusions: The ascending-descending aortic bypass through a posterior pericardial approach is a safe operation and is effective in relieving obstruction and improving hypertension.