Aim: Operation for aortic coarctation and/or hypoplastic arch in adults represents a surgical challenge because of the hazard of spinal cord ischemia due to aortic cross-clamping, laceration of the recurrent nerve, and the choice of the best approach. We demonstrate the results of 22 operations of an anatomical bypass technique via left posterolateral thoracotomy approach without the establishment of cardiopulmonary bypass. Material and Method: Since 2002, 22 patients underwent anatomically positioned arcus aorta-descending aorta bypass grafting. Inclusion criteria for this technique were an aortic arch adequate size for partial exclusion with a side biting clamp, hypoplastic aortic isthmus with multiple large collateral intercostal arteries and the absence of significant intracardiac defects. Mean age of the patients was 25.9 years. Mean systolic pressure gradients at rest was 57.3 mmHg; upper extremity hypertension was present in all patients. The operative technique consisted of performing aortic arch-descending aorta bypass graft size 16 or 26 mm in diameter, via left thoracotomy. Results: There was no morbidity and mortality. Mean arterial pressure gradient was 6.9 mmHg. During a follow-up period of actually 36.2 months, no adverse event was noticed, and antihypertensive medication was reduced in all patients. Discussion: Aortic arch-to-descending aortic bypass via left thoracotomy is a safe and effective method for managing complex coarctation and hypoplastic aortic arch in the adult population.