Left subclavian-aortic bypass grafting in primary isolated adult coarctation.

In the adult patient, bypassing the coarcted segment with a tube graft has been described, among others, as a method of repair in re-do cases and in high-risk patients. Since 1992, and owing to its simplicity, it has become our elected approach in all adult cases. Twenty-two patients (mean age 22.8+/-7.18 years) with isolated aortic coarctation distal to the left subclavian artery were primarily treated with left subclavian-lower descending thoracic aorta bypass using a Hemashield woven double velour graft. There was no hospital mortality nor major postoperative complications. The patients were followed-up for a mean period of 2.36+/-1.29 years (range 1-5 years). Systolic blood pressure as well as the pressure gradient across the coarcted segment dropped significantly from 181.82+/-15.7/65.7+/-13.3 mm Hg to 124+/-13.63/7.41+/-6.49 mm Hg (P = 0.009 and 0.001). Sixteen patients (72.6%) were recorded to be symptom-free and normotensive and seven patients (31.8%) did not show any residual pressure gradient when last seen. The postoperative systolic pressure correlated positively with its preoperative value (P = 0.017) as well as with patient age (P = 0.015). Partial correlation, however, suggested that advanced age upon surgery was the determinant factor responsible for residual postoperative systemic hypertension (P = 0.007). Besides being simple, the procedure is low-risk, permits a significant drop in pressure gradient and improves systolic hypertension through an intermediate follow-up period.