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


CONCLUSIONS
Primary biventricular repair is a safe alternative to staged repair in all cases of aortic hypoplasia with ventricular septal defect and normal left ventricle.
Gruber
Peter J
PJ
Pediatric Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. gruber@email.chop.edu
Fuller
Stephanie
S
Cleaver
Kathryn M
KM
Abdullah
Ibrahim
I
Gruber
Stephen B
SB
Nicolson
Susan C
SC
Gaynor
J William
JW
Wernovsky
Gil
G
Spray
Thomas L
TL
D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000453:epidemiology* / Q000601:surgery*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000453:epidemiology* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome