title: Complications of extra-anatomic aortic bypass for complex coarctation and aortic arch hypoplasia.
abstract: BACKGROUND
  We have adopted the extra-anatomic bypass graft as the procedure of choice for the treatment of coarctation and aortic arch hypoplasia in the adult-sized patient. However, we have experienced prolonged chest drainage and have decided to investigate this complication and the morbidity related to this procedure.
  
  
  METHODS
  Between 1996 and 2010, 15 extra-anatomic bypass grafts of the aorta were performed in 14 patients. Their hospital records and follow-up data were retrospectively reviewed and compared with those of 14 consecutive patients operated with other conventional techniques over the same time period.
  
  
  RESULTS
  There was no hospital mortality. After the extra-anatomic bypass procedure, patients had longer hospital stay because of prolonged pleural effusions. Four patients developed complications related to persistent effusions leading to reinterventions, which led to mediastinitis in 2 instances. At last follow-up, 2 of 14 patients with extra-anatomic bypass remained hypertensive, while 8 of the 14 patients who underwent other types of repair had arch obstruction, were hypertensive, or both.
  
  
  CONCLUSIONS
  In the adult-sized patient extra-anatomic bypass of the aortic arch relieves arch obstruction more effectively than conventional techniques. However, this technique is fraught with complications related to prolonged effusion drainage that may lead to mediastinitis and reintervention. Its indication should be weighted carefully.
authors.affiliation: Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Johann
authors.initials: J
authors.lastname: Brink
authors.forename: Melissa G Y
authors.initials: MG
authors.lastname: Lee
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
authors.forename: Michael M H
authors.initials: MM
authors.lastname: Cheung
authors.forename: T H
authors.initials: TH
authors.lastname: Goh
authors.forename: Martin
authors.initials: M
authors.lastname: Bennett
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
mesh_terms: D000293:Adolescent; D001013:Aorta, Thoracic / Q000002:abnormalities* / Q000601:surgery*; D001017:Aortic Coarctation / Q000150:complications* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000009:adverse effects