Bypass grafts for recurrent or complex coarctations of the aorta.

Twenty-three patients aged 5 to 53 years with recurrent or complex coarctations of the aorta were successfully operated upon using bypass grafts. This technique of repair was selected for 5 patients with recurrent coarctation, 11 with long-segment coarctation with or without hypoplasia of the transverse aortic arch, and 7 with inadequate collateral circulation. Nineteen patients had bypass grafts from the left subclavian artery to the distal descending thoracic aorta. The other 4 had a combined approach through a left thoractomy and median sternotomy with grafts between the ascending and descending thoracic aorta. All patients survived the operative procedure. One patient were reexplored for a hemothorax and 5 developed transient postoperative hypertension. There were no instances of abdominal vasculitis or lower extremity paralysis. These patients have been followed from 3 months to 11 years postoperatively, and all but 1 are alive and well. Twenty-two are normotensive, and none have the sequelae of hypertensive disease. Gradients up to only 15 mm Hg exist between upper and lower extremity blood pressures. Five patients have undergone postoperative catheterization and aortography, and all have patent grafts. This procedure is a useful and adjunct in difficult coarctations of the aorta and can be safely performed with excellent reproducible long-term results.