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Complications of extra-anatomic aortic bypass for complex coarctation and aortic arch hypoplasia

Johann Brink1, Melissa G Y Lee, Igor E Konstantinov

  • 1Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.

The Annals of Thoracic Surgery
|December 4, 2012
PubMed

Insights

Extra-anatomic bypass grafts effectively treat aortic arch obstruction in adults but can lead to prolonged chest drainage and complications like mediastinitis. Careful consideration of this procedure

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Medical Devices

Background:

  • Extra-anatomic bypass grafts are a preferred treatment for adult coarctation and aortic arch hypoplasia.
  • Prolonged chest drainage is a noted complication of this procedure.

Purpose of the Study:

  • To investigate complications and morbidity associated with extra-anatomic bypass grafts for aortic arch obstruction.
  • To compare outcomes of extra-anatomic bypass grafts with conventional surgical techniques.

Main Methods:

  • Retrospective review of 15 extra-anatomic bypass grafts in 14 adult patients (1996-2010).
  • Comparison with 14 consecutive patients undergoing conventional aortic arch repair techniques.

Main Results:

  • No in-hospital mortality observed.
  • Extra-anatomic bypass patients experienced longer hospital stays due to prolonged pleural effusions.
  • Four patients required reintervention for effusions, with two developing mediastinitis.
  • At follow-up, 2/14 extra-anatomic bypass patients were hypertensive vs. 8/14 conventional repair patients with residual arch obstruction or hypertension.

Conclusions:

  • Extra-anatomic bypass effectively relieves adult aortic arch obstruction compared to conventional methods.
  • The technique carries risks of prolonged effusion drainage, mediastinitis, and reintervention.
  • Careful patient selection and indication assessment are crucial for extra-anatomic bypass procedures.
Abstract

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