title: Posterior pericardial ascending-to-descending aortic bypass through median sternotomy.
abstract: OBJECTIVE
  Adult patients with complex forms of descending aortic disease remain a surgical challenge and have a high risk of postoperative mortality and morbidity. Surgical management may be complicated when there is an associated cardiac defect, necessitating repair, or a hostile anatomy exists. We present our experience with extra-anatomic bypass through posterior pericardial route at the same stage with intracardiac/ascending aortic aneurysm repair.
  
  
  METHODS
  Patients that underwent one-stage surgery with posterior pericardial bypass between ascending and descending aorta during 2003-2007 were reviewed. Data from early and mid-term follow-up, including mortality, perioperative blood loss, graft-related complications, patency, and persistent hypertension, were noted.
  
  
  RESULTS
  Six male patients with a mean age of 20.8 +/- 0.7 years were operated for coarctation of the aorta associated with additional pathologies (three cases of ascending aortic aneurysm-one with associated aortic valve insufficiency, one case of isolated aortic valve regurgitation, two cases of mitral valve regurgitation). No early or mid-term mortality was observed during follow-up of a mean of 21.6 +/- 10.0 months. No late graft-related complications or reoperations were observed with patent grafts. Systolic blood pressure decreased after surgery by an average of 43 mmHg.
  
  
  CONCLUSIONS
  Coarctation of the aorta with concomitant cardiac lesions can be repaired simultaneously through sternotomy and posterior pericardial approach, when patients present in adulthood, to minimize morbidity and mortality.
authors.affiliation: Gulhane Military Academy of Medicine, Department of Cardiovascular Surgery, Haydarpasa, Istanbul, Turkey. onurgokseljet@gmail.com
authors.forename: Onur S
authors.initials: OS
authors.lastname: Goksel
authors.forename: Kaan
authors.initials: K
authors.lastname: Inan
authors.forename: Alper
authors.initials: A
authors.lastname: Uçak
authors.forename: Veysel
authors.initials: V
authors.lastname: Temizkan
authors.forename: Tolga
authors.initials: T
authors.lastname: Tatar
authors.forename: Sinan
authors.initials: S
authors.lastname: Sahin
authors.forename: Melih H
authors.initials: MH
authors.lastname: Us
authors.forename: Ahmet T
authors.initials: AT
authors.lastname: Yilmaz
mesh_terms: D000328:Adult; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery; D001017:Aortic Coarctation / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010496:Pericardium / Q000601:surgery*; D013249:Sternum / Q000601:surgery*; D013599:Systole