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J Thorac Cardiovasc Surg 2007;133:1504-1509
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

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

^a Clinician Investigator Program, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn
^b Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
^c Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Received for publication October 5, 2006; revisions received November 10, 2006; accepted for publication November 16, 2006.

^_* Address for reprints: Hartzell V. Schaff, MD, Division of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

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.

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