Posterior pericardial approach for ascending aorta-to-descending aorta bypass through a median sternotomy

Background. Bypass grafting for repeat operation or complex forms of descending aortic disease is an alternative approach to decrease potential complications of anatomic repair. Methods. Between December 1985 and February 1998, 17 patients (13 men, 4 women; mean age, 47.6 ± 18.5 years) underwent ascending aorta-to-descending aorta bypass through a median sternotomy and posterior pericardial approach. Indications for operation were coarctation or recoarctation of aorta in 8 patients, Takayasu's aortitis in 2, prosthetic aortic valve stenosis associated with coarctation of aorta, complex descending aortic arch aneurysm, reoperation for chronic descending aortic dissection, long-segment stenosis of descending aorta, acquired coarctation after repair of traumatic transection of descending aorta, severe aortic atherosclerosis, and false aneurysm of descending aorta after repair of coarctation in 1 patient each. Concomitant procedures were performed in 12 patients. Results. No early or late mortality has occurred. Follow-up was 100% complete and extended to 12 years (mean, 2.7 ± 3.3 years). No late graft-related complications have occurred; 1 patient had successful repair of perivalvular leak after mitral valve replacement, and 1 patient had replacement of lower descending and abdominal aorta. Conclusions. Exposure of the descending aorta through the posterior pericardium for ascending aorta- descending aorta bypass is a safe alternative and particularly useful when simultaneous intracardiac repair is necessary. (C) 2000 by The Society of Thoracic Surgeons.