Ascending-to-descending aortic extra-anatomic graft.

A 71-year-old woman with isthmic aortic coarctation underwent aortic valve replacement and coronary bypass. Before aortic clamping, end-to-side anastomosis to descending aorta was performed. After cardiac surgery, the graft was directed posterior to the inferior vena cava and anastomosed to the ascending aorta by using a side-biting clamp (Fig. 1). Fig. 1. Three-dimensional computed tomographic image (18-month post-operatively) showing isthmic aortic coarctation and ascending-to-descending aortic bypass performed using an 18 mm Dacron graft. The postoperative outcome was uneventful and the patient continues to do well 25 months postoperatively.