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

Y Isomatsu1, Y Imai, T Shin'oka

  • 1Department of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.

The Journal of Thoracic and Cardiovascular Surgery
|September 8, 2001
PubMed

Insights

Two-stage repair effectively manages coarctation of the aorta with ventricular septal defect, showing low mortality and recoarctation rates. This approach minimizes complications associated with circulatory arrest and blood transfusions.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Cardiovascular Surgery

Background:

  • Management of coarctation of the aorta (CoA) and ventricular septal defect (VSD) is complex.
  • Optimal surgical strategy for this combined defect remains debated.
  • This study evaluates the outcomes of a two-stage repair approach.

Purpose of the Study:

  • To assess the effectiveness of a two-stage repair for coarctation of the aorta and ventricular septal defect.
  • To determine the incidence of recoarctation following this surgical strategy.
  • To evaluate overall mortality and morbidity in the studied patient cohort.

Main Methods:

  • A cohort of 79 infants under 3 months underwent a two-stage repair between 1984 and 1998.
  • The first stage involved subclavian flap angioplasty and pulmonary banding.
  • The second stage included ventricular septal defect closure and pulmonary debanding after a mean interval of 10.4 months.

Main Results:

  • Hospital and late mortality rates were low, with 92.3% 10-year survival.
  • The freedom from recoarctation rate at 10 years was 90.4%.
  • Factors like age, weight, hypoplastic arch, or coexisting anomalies did not significantly impact mortality.

Conclusions:

  • Two-stage repair is an effective technique for managing coarctation of the aorta with ventricular septal defect.
  • This approach reduces mortality and the rate of recoarctation.
  • It also minimizes complications related to circulatory arrest and allogeneic blood transfusions.
Abstract

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