Objective To explore of a surgical approach of posterior pericardial ascending-to-descending aortic bypass through a median sternotomy for complex coarctation and interrupted aortic arch adult patients with coexistent cardiac disorder. Methods We retrospectively reviewed the clinical data of 2 adult patients with complex coarctation and 1 adult patient with interrupted aortic arch and all with coexistent cardiac disorder who underwent ascending-to-descending aortic bypass in our hospital between April 2010 and January 2015. There were 2 males and 1 female with age of 35.6 (27-46) years. One patient was with complex coarctation, and prolapse of anterior mitral leaflet with moderate regurgitation. One patient was with complex coarctation, and bicuspid aortic valve with severe aortic regurgitation, and ascending aortic aneurysm. One patient was with interrupted aortic arch (type A), and bicuspid aortic valve with mild stenosis, and secundum atrial septal defect. The surgical approach used in all patients was the median sternotomy. After aorta, femoral artery and bicaval cannulation, hypothermic cardiopulmonary bypass was established. With posterior pericardial ascending-to-descending aortic bypass procedure for repair of complex coarctation and interrupted aortic arch with coexistent cardiac disorder. Results There was no death. The symptoms of the patients obviously improved. All the patients were alive with ascending-to-descending aortic bypass procedure at a mean follow-up ranged from 2 to 59 months. Except that one patient had residual upper-extremity hypertension, and needed antihypertensive medications taken postoperatively, other patients’ systolic blood pressure returned to normal level. All patients’ lower-extremity fatigability resolved. Postoperative computed tomography angiography (CTA) of the patients showed that dacron graft was unobstructed with no graft-related complications of kinking and narrowing, development of false aneurysms or other complications. Conclusion The surgical management of adult patients’ complex coarctation and interrupted aortic arch with coexistent cardiac disorder, a one-stage approach using pericardial ascending-to-descending aortic bypass through a median sternotomy is an alternative surgery.