Interposition of a prosthetic graft between the ascending aorta and the abdominal aorta in the treatment of complicated or longstanding coarctations in adults

Although the direct approach to the aortic isthmus is unquestionable for an isolated coarctation of the thoracic aorta, recurrent coarctations of coarctation with associated cardiac lesions require a concomitant procedure, raise difficult surgical problems and expose to a high operative risk. Another technique consists of performing an ascending aorta-abdominal aorta by-pass, with a prosthetic tube. From 1977 to 1988, this technique was performed in 8 patients: 3 with recurrent coarctations, 4 with coarctation associated with a surgical aortic insufficiency (2 ascending aortic aneurysms with aortic insufficiency) and 1 with abdominal aorta coarctation. The mean age was 48.3 years (range from 31 to 72 years), the mean follow-up was 44.3 months (range from 4 months to 10 years 5 months). There was no mortality and no morbidity during the follow-up. The functional result is good, without high blood pressure and with no blood pressure difference between the arms and the legs. Postoperative angiographies showed that all the by-passed were patent.