Extra-anatomical ascending-to-descending aortic bypass in an adult patient with aortic coarctation

Aortic coarctation is typically diagnosed in infancy, but some cases present in adulthood, posing significant risks including aortic dissection, myocardial infarction and heart failure. In adults requiring complex aortic or cardiac interventions, extra-anatomical ascending-to-descending aortic bypass via median sternotomy is a preferred surgical option due to its reduced risk of spinal cord ischaemia and recurrent laryngeal nerve injury. We present the case of a 55-year-old woman with lifelong hypertension and severe headaches. Transthoracic echocardiography revealed a significant narrowing at the aortic isthmus with elevated peak velocity and pressure gradients. Contrast-enhanced computed tomography confirmed 80% narrowing without aneurysmal changes. The patient underwent an extra-anatomical bypass using a 16mm interposition graft via median sternotomy. The graft was routed behind the left ventricle and over the left pulmonary artery to connect the ascending and descending aorta. Intra-operative haemodynamic improvement was immediate, with normalization of upper and lower body pressures. Post-operative imaging confirmed correct graft positioning without stenosis or kinking. The patient recovered uneventfully and was discharged on post-operative Day 12. This case demonstrates the safety and effectiveness of extra-anatomical bypass via sternotomy in adult coarctation, offering a viable alternative to thoracotomy in anatomically and surgically complex scenarios.