Off-pump reconstruction of pseudoaneurysm of the descending thoracic aorta

We report 2 cases of postoperative pseudoaneurysm of the descending thoracic aorta, repaired successfully by temporary bypass graft without extracorporeal bypass. One patient presented with a large recurrent pseudoaneurysm that developed 30 years after ligation of a patent ductus arteriosus. The other patient presented with a pseudoaneurysm 18 years after thoracic aortic reconstruction for a traumatic aneurysm. In both cases, a temporary bypass graft was created from a major branch of the aortic arch to the femoral artery prior to definitive reconstruction. The postoperative course was uncomplicated by organ dysfunction or neurologic deficit. Creation of a temporary bypass graft can avoid the need for cardiopulmonary bypass in selected patients. By avoiding heparin use, blood loss is decreased, especially when dense pulmonary adhesions from previous surgery are present.