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J Thorac Cardiovasc Surg 2001;122:524-528
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Coarctation of the aorta and ventricular septal defect: Should we perform a single-stage repair?

From the Department of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.

Received for publication Oct 10, 2000. Revisions requested Jan 16, 2001; revisions received Feb 16, 2001. Accepted for publication Feb 26, 2001. Address for reprints: Yukihisa Isomatsu, MD, Department of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan.

Abstract

Background: Optimal management for coarctation of the aorta and ventricular septal defect remains controversial. The current study was undertaken to determine outcome, including recoarctation after 2-stage repair, at our institution.
Methods: Between 1984 and 1998, 79 patients younger than 3 months with coarctation and ventricular septal defect underwent 2-stage repair at our institution. The first-stage operation consisted of subclavian flap angioplasty and pulmonary banding. The median age at the time of first operation was 28 days (range, 4-90 days), and median weight was 3.2 kg (range, 1.2-5.1 kg). Hypoplastic aortic arch was present in 27 patients, and coexisting anomalies were present in 13 patients. After a mean interval of 10.4 ± 9.6 months, they underwent a second-stage repair, with closure of the ventricular septal defect and pulmonary debanding.
Results: There were 2 hospital deaths and 4 late deaths. Mean follow-up was 9.2 ± 4.9 years (range, 2.0-18.3 years), and actuarial survival was 92.3% at 10 years (95% confidence interval, 86.6%-98.3%). Age at first operation, body weight, hypoplastic arch, and coexisting anomalies had no significant influence on overall mortality. Freedom from recoarctation rate was 90.4% at 10 years (95% confidence interval, 83.7%-97.2%).
Conclusion: To diminish mortality and the recoarctation rate and also to decrease the possibility of complications related to circulatory arrest and allogeneic blood transfusion, 2-stage repair is still an effective technique for coarctation of the aorta associated with ventricular septal defect.

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