Cardiovascular Surgery, Vol. 7, No. 3, pp. 351–354, 1999  1999 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd All rights reserved. Printed in Great Britain 0967–2109/99 $20.00 + 0.00 PII: S0967-2109(98)00164-1 Left subclavian-aortic bypass grafting in primary isolated adult coarctation A. Elkerdany, A. Hassouna, T. Elsayegh, Sh. Azab and M. Bassiouni Department of Cardiovascular and Thoracic Surgery, Ain-Shams University Hospitals, Cairo, Egypt In the adult patient, bypassing the coarcted segment with a tube graft has been described, among others, as a method of repair in re-do cases and in high-risk patients. Since 1992, and owing to its simplicity, it has become our elected approach in all adult cases. Twenty-two patients (mean age 22.8  7.18 years) with isolated aortic coarctation distal to the left sub- clavian artery were primarily treated with left subclavian-lower descending thoracic aorta bypass using a Hemashield woven double velour graft. There was no hospital mortality nor major postoperative complications. The patients were followed-up for a mean period of 2.36  1.29 years (range 1–5 years). Systolic blood pressure as well as the pressure gradient across the coarcted segment dropped significantly from 181.82  15.7/65.7  13.3 mmHg to 124  13.63/7.41  6.49 mmHg (P = 0.009 and 0.001). Sixteen patients (72.6%) were recorded to be symptom-free and normotensive and seven patients (31.8%) did not show any residual pressure gradient when last seen. The postoperative systolic pressure correlated positively with its preoperative value (P = 0.017) as well as with patient age (P = 0.015). Partial corre- lation, however, suggested that advanced age upon surgery was the determinant factor responsible for residual postoperative systemic hypertension (P = 0.007). Besides being sim- ple, the procedure is low-risk, permits a significant drop in pressure gradient and improves systolic hypertension through an intermediate follow-up period.  1999 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved. Keywords: adult, blood vessel prosthesis, coarctation, follow-up studies, hypertension Introduction Isolated aortic coarctation is classically repaired by resection and end-to-end anastomosis, interposition of a tube graft, subclavian flap or synthetic patch aor- toplasty. In the adult patient, however, resection involves mobilization of a relatively immobile aorta with large collaterals adjacent to the coarcted seg- ment, which carries the hazard of serious intraoper- ative [1] or postoperative [2] haemorrhage. It is advisable not to sacrifice the adult left subclavian artery for fear of limb ischaemia, and patch aortopla- sty is associated with late aneurysm formation in as many as 20% of patients [3]. All these options necessitate the division of a number of intercostal Correspondence to: Dr Ahmed Hassouna, PO Box 93, El Mukattam, 11571 Cairo, Egypt. E-mail: ruhasona@rusys.eg.net CARDIOVASCULAR SURGERY APRIL 1999 VOL 7 NO 3 351 arteries and total cross-clamping of the aorta, which may lead to sacrificing the radicular artery, or more commonly, its inadequacy during aortic cross- clamping results in the rare but serious hazard of paraplegia [4]. Since 1992, the authors’ policy has been to use a left subclavian-descending thoracic aorta bypass graft in all adult patients with primary aortic coarc- tation distal to the left subclavian artery. The pur- pose of this report is to evaluate the safety and effi- cacy of this procedure and provide intermediate- term follow-up results. Methods Between January 1992 and January 1997, 22 con- secutive adult patients were referred to our depart- ment for surgical treatment of primary isolated coarctation of the aorta distal to the left subclavian