Outcome following single-stage repair of coarctation with ventricular septal defect.
OBJECTIVE
A recent multi-institutional study suggested improved survival (97%) after staged repair of coarctation with ventricular septal defect (VSD) compared with single-stage repair. The current study was undertaken to determine outcome and need for reintervention following single-stage repair of coarctation and VSD at our institution.


METHODS
Retrospective review of patients undergoing single-stage repair of coarctation with VSD between October 1, 1994 and August 15, 1999.


RESULTS
Single-stage repair of coarctation with VSD was performed in 25 infants (12 males, 13 females) at a median age of 12 days (range 1-87 days) and median weight of 3.3 kg (range 1.3-4.4 kg). The VSD was conoventricular in ten patients, malalignment type with posterior deviation of the infundibular septum in ten, muscular in four and conal septal hypoplasia in one. Arch hypoplasia was present in all patients and bicuspid aortic valve in 13. At least moderate subaortic narrowing was present in six patients (secondary to prolapse of tricuspid valve tissue across the VSD in four). Repairs were performed via a median sternotomy with a mean circulatory arrest time of 38+/-12 min. Overall patient survival was 96% with one operative death and no late deaths at a median follow-up of 16 months (range 1-50 months). Reinterventions included balloon dilatation of recurrent coarctation (five), closure of residual VSD (one) and Ross-Konno procedure (two). Actuarial freedom from reintervention for the hospital survivors was 81% (95% confidence limit (CL) 61%, 92%) at 6 months, 71% (95% CL 47%, 87%) at 1 year and 59% (95% CL 31%, 82%) at 2 years following surgery.


CONCLUSIONS
Single-stage repair of coarctation with VSD can be performed with low operative mortality and good midterm survival equivalent to reported results for staged repair.
Gaynor
J W
JW
Divisions of Pediatric Cardiothoracic Surgery and Pediatric Cardiology, The Cardiac Center, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Suite 8527, Philadelphia, PA 19104, USA. gaynor@email.chop.edu
Wernovsky
G
G
Rychik
J
J
Rome
J J
JJ
DeCampli
W M
WM
Spray
T L
TL
D001017:Aortic Coarctation / Q000150:complications* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016019:Survival Analysis; D016896:Treatment Outcome