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J. William Gaynor
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Right arrow Congenital - acyanotic

J Thorac Cardiovasc Surg 2006;132:260-263
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Early results of single-stage biventricular repair of severe aortic hypoplasia or atresia with ventricular septal defect and normal left ventricle

Peter J. Gruber, MD, PhD a , * , Stephanie Fuller, MD a , Kathryn M. Cleaver, BS b , Ibrahim Abdullah, MD c , Stephen B. Gruber, MD, PhD d , Susan C. Nicolson, MD a , J. William Gaynor, MD a , Gil Wernovsky, MD a , Thomas L. Spray, MD a

a Children's Hospital of Philadelphia, Philadelphia, Pa
b Vanderbilt University School of Medicine, Nashville, Tenn
c Hospital of the University of Pennsylvania, Philadelphia, Pa
d University of Michigan, Ann Arbor, Mich

Read at the Thirty-first Annual Meeting of the Western Thoracic Surgical Association, Victoria, BC, Canada, June 22-25, 2005.

Received for publication June 17, 2005; revisions received February 13, 2006; accepted for publication February 16, 2006.

* Address for reprints: Peter J. Gruber, MD, PhD, Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Suite 8527, 34th St and Civic Center Blvd, Philadelphia, PA 19104 (Email: gruber{at}email.chop.edu).

OBJECTIVE: Biventricular repair of aortic atresia (or severe aortic hypoplasia) is possible in the presence of a ventricular septal defect and normal left ventricle. We considered whether primary biventricular repair was a safe alternative in all cases, even in the presence of interrupted aortic arch.

METHODS: This was a retrospective analysis of patients who underwent primary biventricular repair consisting of a combination Norwood-type reconstruction of the aortic arch, baffle of the left ventricle to both semilunar roots, and conduit placement from the right ventricle to pulmonary arteries.

RESULTS: Between January 1995 and January 2005, a total of 21 patients underwent primary biventricular repair at a median age of 5 days and a median weight of 3.0 kg. Aortic atresia was present in 7 and aortic stenosis in 14; 6 had interrupted aortic arch. All patients with aortic stenosis had annular diameters 3 mm or smaller. Median circulatory arrest time was 55 minutes, aortic crossclamp time was 56 minutes, and total support time was 99 minutes. In-hospital survival was 100%. Postoperative echocardiography in 19 patients demonstrated no significant outflow tract obstruction. Total stay was a median of 17 days. At midterm follow-up, there has been 1 late death, and reoperation has been necessary in 10 cases.

CONCLUSION: Primary biventricular repair is a safe alternative to staged repair in all cases of aortic hypoplasia with ventricular septal defect and normal left ventricle.

Abbreviations and Acronyms VSD = ventricular septal defect




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