Coarctation of the aorta and ventricular septal defect: should we perform a single-stage repair?
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%).


CONCLUSIONS
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.
Isomatsu
Y
Y
Department of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Imai
Y
Y
Shin'oka
T
T
Aoki
M
M
Sato
K
K
D000206:Actuarial Analysis; D001017:Aortic Coarctation / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects; D006345:Heart Septal Defects, Ventricular / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D013348:Subclavian Artery / Q000601:surgery; D013524:Surgical Flaps; D016019:Survival Analysis; D065227:Transfusion Reaction; D016896:Treatment Outcome