Extra anatomic aortic bypass for repair of recurrent aortic arch coarctation via sternotomy: two case reports

Coarctation of the aorta is commonly associated with congenital and acquired cardiac pathology that may require surgical intervention.[1,2]In addition,5% to 30% of patients with previous coarctation repair have recoarctation and require reintervention[3-5].Adult patients with native or recurrent coarctation with or without associated intracardiac diseases pose a surgical challenge.There is no consensus on the optimal approach for these patients.Several extra-anatomic bypass grafting techniques have been described,including methods in which the distal anastomosis is performed on the descending thoracic aorta,supraceliac abdominal aorta,or the infrarenal abdominal aorta.[3,4,6-9] In 1980,Vijayanagar et al[10] described exposure of the descending thoracic aorta through a median sternotomy and posterior pericardium.This procedure allowed bypass of coarctation with concomitant aortic valve replacement. Aditional reports detail modifications of this procedure for complex forms of aortic coarctation[11].The present case report reviews two cases of recurrent coactation that underwent ascending to descending aortic bypass.