Objective To summarize the experience with median sternotomy ascending-descending thoracic aortic bypass grafting via median sternotomy for the treatment of complex coarctation of aorta (COA), and to present the intermediate to long-term follow-up outcomes. Methods A retrospective analysis was performed on patients with complex COA who underwent ascending-descending thoracic aortic bypass grafting through a median sternotomy in the First Hospital of Tsinghua University from August 2004 to May 2017. ResultsA total of 7 children were enrolled, including 4 males and 3 females, with an average age of (13.3±4.6) years and an average weight of (40.2±12.2) kg. Six (85.7%) patients had hypertension in the upper limbs. Among them four patients had coarctation associated with intracardiac anomalies, two with recurrent coarctation post-surgery, and one with both recurrent coarctation and intracardiac anomalies. All surgeries were performed under cardiopulmonary bypass, with no operative mortality or severe complications. The systolic pressure gradient between the upper and lower extremities decreased significantly from preoperative (51.4±13.5) mm Hg to postoperative (2.9±2.7) mm Hg (P<0.01). During a follow-up period of (14.9±5.9) years (ranging from 7 to 19 years), there were no late deaths or graft-related complications. Except for one patient who continued to have mild hypertension, the blood pressure of all other patients returned to normal. Conclusion The ascending-descending thoracic aortic bypass grafting via median sternotomy for complex COA is a safe and reliable procedure that effectively reduces upper limb blood pressure and the pressure difference between the upper and lower extremities. It has a low rate of complications and satisfactory intermediate to long-term outcomes.