title: Intermediate-term results of ascending-descending posterior pericardial bypass of complex aortic coarctation.
abstract: 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.
authors.affiliation: Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: McKellar
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Mullany
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Orszulak
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.forename: Carole A
authors.initials: CA
authors.lastname: Warnes
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Puga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001017:Aortic Coarctation / Q000150:complications / Q000601:surgery*; D001027:Aortography; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery; D016896:Treatment Outcome