Surgical management of coarctation of the aorta in adults with concurrent cardiac and aortic disease.

We evaluated our experience with the surgical management of aortic coarctation (ACo) in adults with concurrent cardiac and aortic disease approached via median sternotomy. Eight patients were presented using a variety of repair techniques including end-to-end anastomosis, transpericardial ascending aorta to descending aorta bypass, and stage 1 elephant trunk insertion. All patients were male and symptomatic at presentation. The average age was 41 years (range, 27-67 years). The systolic blood pressure decreased by a mean of 49 mmHg in the patients presenting with hypertension. The postoperative New York Heart Association functional class was I or II in all patients. Mean length of stay was 7.7 days. There were no perioperative complications, and overall survival was 100%. Operative repair of complex ACo can be safely accomplished through the mediastinum in patients in whom a conventional left thoracotomy may not be the preferred approach.