The usual surgical approach for bypassing coarctation of the aorta is typically a left thoracotomy without cardiopulmonary bypass. This approach allows surgeons to access the descending aorta effectively for resection of the coarctation and subsequent anastomosis. A left thoracotomy provides an optimal field of view and direct access to the thoracic aorta, which makes it easier to perform the necessary surgical corrections.
The choice to perform this procedure without cardiopulmonary bypass is common because the blood flow can often be managed adequately through direct perfusion from the heart or through collateral circulation during the procedure. This can help minimize risks associated with CPB, particularly in pediatric cases, where the use of CPB might not be warranted unless the anatomy or associated conditions dictate otherwise.
Other surgical approaches, such as median sternotomy or right thoracotomy, can be used in specific circumstances, but they are not typically the first line in cases of coarctation due to the advantages that the left thoracotomy offers in terms of direct access and reduced need for bypass. The transcatheter approach is a less invasive alternative mainly utilized for certain patients but does not represent the conventional surgical approach for bypassing the coarctation