Combined aortic valve replacement and extra-anatomic aorta ascending-descending bypass for recurrent aortic coarctation.

Aortic recoarctation may be difficult to manage, especially in patients with the need for additional surgical interventions. We describe the case of a 45-year-old man with grown-up congenital heart disease, presenting with recoarctation after initial anatomic repair with a prosthetic graft at the age of 16 years. Further examination revealed heart failure and left ventricular dilation because of severe aortic regurgitation, owing to a bicuspid aortic valve. Through a median sternotomy and CPB, an aortic valve replacement and extra-anatomic ascending-to-descending aortic-bypass-grafting was performed with a posterior pericardial approach. Off-pump coronary artery bypass techniques were applied to reach the descending aorta.