Technique of Single-Stage Repair of Coarctation of the Aorta With Ventricular Septal Defect

Background: We sought to compare clinical outcomes and resource utilization for two surgical approaches for single-stage repair of coarctation of the aorta and ventricular septal defect (VSD). Methods: This was a retrospective chart review of 21 consecutive neonates and infants undergoing single-stage repair of coarctation of the aorta and VSD. Group 1 included 13 patients with both arch repair and VSD repair completed via sternotomy. Group 2 included eight patients with off-pump arch repair via left thoracotomy followed by repositioning and VSD repair via sternotomy. Primary clinical outcome was arch reintervention. Secondary outcomes included various measures of resource utilization. Results: Group 1 patients demonstrated younger age at repair (median of 10 days vs 57 days for group 2; P = .05) and lower proximal arch z scores (−4.2 vs −2.3 for group 2; P = .003). Arch reintervention occurred in 0 of 8 patients in group 2 and 1 (7.7%) of 13 patients in group 1 ( P = nonsignificant). Group 2 was associated with lower total charges (US$68,301 vs US$211,723 for group 1; P = .0007), shorter length of stay (8 days vs 23 days for group 1; P = .004), and shorter duration of postoperative mechanical ventilation (0.5 days vs 4.0 days for group 1; P = .0008). Group 2 was also associated with shorter total cardiopulmonary bypass time (86 minutes vs 201 minutes for group 1; P = .0009). Conclusion: Single-stage two-incision repair of coarctation and VSD in appropriately selected patients may be associated with higher value of care. Confirmation of this finding will require further study based on larger numbers of patients.

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Single-stage versus 2-stage repair of coarctation of the aorta with ventricular septal defect

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2008.06.039 ◽

2008 ◽

Vol 136 (5) ◽

pp. 1390-1391 ◽

Cited By ~ 2

Author(s):

Sachin Talwar ◽

Shiv Kumar Choudhary ◽

Balram Airan

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Coarctation Of The Aorta ◽

Single Stage ◽

Stage Versus

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Coarctation of the aorta and ventricular septal defect: Should we perform a single-stage repair?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1067/mtc.2001.115425 ◽

2001 ◽

Vol 122 (3) ◽

pp. 524-528 ◽

Cited By ~ 26

Author(s):

Yukihisa Isomatsu ◽

Yasuharu Imai ◽

Toshiharu Shin'oka ◽

Mitsuru Aoki ◽

Kazuki Sato

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Coarctation Of The Aorta ◽

Single Stage

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Single-stage versus 2-stage repair of coarctation of the aorta with ventricular septal defect

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2007.12.008 ◽

2008 ◽

Vol 135 (4) ◽

pp. 754-761 ◽

Cited By ~ 17

Author(s):

Henry L. Walters ◽

Constantine E. Ionan ◽

Ronald L. Thomas ◽

Ralph E. Delius

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Coarctation Of The Aorta ◽

Single Stage ◽

Stage Versus

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One-Stage Repair of Cardiac and Arch Anomalies without Circulatory Arrest

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230301100315 ◽

2003 ◽

Vol 11 (3) ◽

pp. 250-254 ◽

Cited By ~ 1

Author(s):

Kona Samba Murthy ◽

Robert Coelho ◽

Christopher Roy ◽

Snehal Kulkarni ◽

Benjamin Ninan ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Aortic Arch ◽

Septal Defect ◽

Circulatory Arrest ◽

Coarctation Of The Aorta ◽

Innominate Artery ◽

Double Outlet Right Ventricle ◽

Interrupted Aortic Arch ◽

Ischemic Time ◽

Arch Obstruction

Between 1999 and 2002, 23 patients underwent single-stage complete repair of cardiac anomalies and aortic arch obstruction, without circulatory arrest. Median age was 1.2 years. Intracardiac defects included ventricular septal defect in 9, double-outlet right ventricle in 6, d-transposition of the great arteries and ventricular septal defect in 2, subaortic obstruction in 3, and atrial septal defect in 3. Fourteen patients had coarctation of the aorta, 6 had coarctation with hypoplastic aortic arch, and 3 had interrupted aortic arch. Simple techniques were employed such as cannulation of the ascending aorta near the innominate artery and maintaining cerebral and myocardial perfusion. After correction of arch obstruction, intracardiac repair was undertaken. The mean cardiopulmonary bypass time was 169 min, aortic crossclamp time was 51 min, and arch repair took 16 min. There was no operative mortality or neurological deficit. In follow-up of 1–43 months, no patient had residual coarctation. This simplified technique avoids additional procedures, reduces ischemic time, and prevents problems related to circulatory arrest.

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Increased Prevalence of Ventricular Septal Defect: Epidemic or Improved Diagnosis

PEDIATRICS ◽

10.1542/peds.83.2.200 ◽

1989 ◽

Vol 83 (2) ◽

pp. 200-203

Author(s):

Gerard R. Martin ◽

Lowell W. Perry ◽

Charlotte Ferencz

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Ductus Arteriosus ◽

Coarctation Of The Aorta ◽

Cardiovascular Malformations ◽

Ventricular Septal Defects ◽

Live Births ◽

Septal Defects ◽

Clinical Diagnoses ◽

Control Study

The Baltimore-Washington Infant Study is an ongoing case-control study of congenital cardiovascular malformations in infants in whom the clinical diagnoses have been confirmed by echocardiography, catheterization, surgery, or autopsy. An increase in the prevalence of ventricular septal defects was detected in 1,494 infants with congenital cardiovascular malformations between 1981 and 1984. The prevalence of congenital cardiovascular malformations increased from 3.6 to 4.5 per 1,000 live births (P<.025) and the prevalence of ventricular septal defect increased from 1.0 to 1.6 per 1,000 live births (P< .001). The increase in ventricular septal defects accounted for the total increase in congenital cardiovascular malformations. The prevalence of isolated ventricular septal defect increased from 0.67 to 1.17 per 1,000 live births (P<.001). The prevalence of ventricular septal defect with associated coarctation of the aorta, patent ductus arteriosus, atrial septal defect, and pulmonic stenosis did not change. The prevalence of ventricular septal defect diagnosed by catheterization, surgery, and autopsy did not change; however, defects diagnosed by echocardiography increased from 0.30 to 0.70 per 1,000 live births (P<.001). It is concluded that the reported increase in prevalence of ventricular septal defect is due to improved detection of small, isolated ventricular septal defects and that there is no evidence of an "epidemic."

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