title: Management of an associated ventricular septal defect at the time of coarctation repair.
abstract: BACKGROUND
  Management of a ventricular septal defect (VSD) at time of coarctation of the aorta (CoA) repair remains controversial, with recent studies advocating concomitant repair of both defects. We evaluated the surgical management and mortality for patients undergoing CoA repair associated with a VSD.
  
  
  METHODS
  We retrospectively reviewed data submitted to the Pediatric Cardiac Care Consortium of patients undergoing repair of CoA from 1982 to 2007. The cohort was divided into three groups: CoA repair plus VSD closure (group 1); CoA repair plus pulmonary artery band (group 2); and CoA repair without repair of VSD (group 3). Variables reviewed included era, age, and weight at repair, and in-hospital mortality.
  
  
  RESULTS
  There were 7,860 patients who underwent repair of CoA, of whom 2,022 had an associated VSD (25.7%). Mortality after CoA repair with and without an associated diagnosis of VSD was 8.3% versus 2.1% (p < 0.001). Mean age at repair for group 1 (n = 286) and group 2 (n = 472) was 87.4 days and 21.6 days, respectively (p = 0.004), and median weight was 3.31 kg and 3.30 kg, respectively (p = 0.130). Discharge mortality for group 1 and group 2 was similar, at 8.7% and 9.1%, respectively (p = 0.852). Patients with CoA/VSD who had neither VSD closure nor pulmonary artery banding (group 3) had a hospital mortality of 7.9%.
  
  
  CONCLUSIONS
  The association of CoA and VSD is common. A strategy of concomitant VSD closure at CoA repair does not result in worse discharge mortality when compared with pulmonary banding with anticipated staged repair of the VSD. These outcomes support continued evaluation of a one-stage approach.
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Plunkett
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Harvey
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Lazaros K
authors.initials: LK
authors.lastname: Kochilas
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Jeremiah S
authors.initials: JS
authors.lastname: Menk
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota. Electronic address: stlou012@umn.edu.
authors.forename: James D
authors.initials: JD
authors.lastname: St Louis
mesh_terms: D001017:Aortic Coarctation / Q000401:mortality / Q000601:surgery*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies