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OBJECTIVE To evaluate the outcome of various surgical approaches in the treatment of renovascular hypertension (rHTN) and midaortic syndrome (MAS) in children. METHODS We performed a retrospective chart review of patients who underwent surgery for rHTN from 2010 to 2018 at our center under the care of a multidisciplinary team. Operative interventions included mesenteric artery growth improves circulation (MAGIC), tissue expander-stimulated lengthening of arteries (TESLA), aortic bypass using polytetrafluorethylene (PTFE) , renal artery re-implantation, and autotransplantation. MAGIC procedure utilizes the meandering mesenteric artery as a free conduit for aortic bypass. TESLA procedure is based on lengthening the normal distal aorta and iliac arteries by gradual filling of a retroaortic tissue expander over several weeks followed by resection of the stenotic aorta and subsequent primary reconstruction. RESULTS Thirty-nine patients were identified, 10 with isolated renal artery stenosis (iRAS), 26 with MAS, and 3 with systemic inflammatory vasculitis. Median age at presentation and surgery were 6.4 (range 0-16.3 years) and 9.3 years (range 0 days-9.2 years), respectively. MAS-associated syndromes included neurofibromatosis 1 (15.4%) and Williams syndrome (5.1%), though most cases were idiopathic. At surgery, 33.3% had stage 1 hypertension (HTN), 53.8% had stage 2 HTN and 12.8% had normal blood pressure on a median of 3 antihypertensive medications. Follow-up of 37 patients at a median of 2.5 years demonstrated normal blood pressure in 86.1%, stage 1 HTN in 8.3%, and stage 2 HTN in 5.6% with a median of 1 medication for the entire cohort. CONCLUSIONS Patterns of vascular involvement leading to renovascular hypertension in children are variable and complex requiring thoughtful multidisciplinary planning and surgical decision-making. MAGIC and TESLA procedures provide feasible approaches for aortic bypass and reconstruction using autologous tissues and result in normalization of blood pressure in 85% of children 2.5 years after surgery.