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What is the optimal management of infants with coarctation and ventricular septal defect?

Kirk R Kanter1, William T Mahle, Brian E Kogon

  • 1Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. kkanter@emory.edu

The Annals of Thoracic Surgery
|July 24, 2007
PubMed

Insights

Surgical management of aortic coarctation and ventricular septal defect (VSD) in infants can be achieved with excellent results using a one-stage, two-incision approach, minimizing cardiopulmonary bypass and improving patient outcomes.

Area of Science:

  • Pediatric Cardiac Surgery
  • Congenital Heart Defects
  • Surgical Outcomes

Background:

  • Management of aortic coarctation and ventricular septal defect (VSD) in infants presents surgical challenges.
  • Previous approaches have included staged or one-stage repairs with varying outcomes.

Purpose of the Study:

  • To evaluate the clinical outcomes of different surgical strategies for infants with coarctation and VSD.
  • To compare the efficacy and safety of staged versus one-stage repair approaches.

Main Methods:

  • Retrospective review of 36 infants with coarctation and VSD managed between 2002 and 2006.
  • Three surgical groups: staged repair (Group I), one-stage one-incision (Group II), and one-stage two-incisions (Group III).
  • Data collected on operative times, cardiopulmonary bypass (CPB) duration, and hospital/ICU length of stay.

Main Results:

  • No mortality observed across all groups.
  • Group III (one-stage, two-incisions) demonstrated significantly shorter ICU and hospital stays compared to Group II.
  • Group II experienced longer CPB and circulatory arrest/perfusion times than Groups I and III.

Conclusions:

  • A one-stage, two-incision surgical approach for coarctation and VSD offers excellent clinical results in infants.
  • This method effectively avoids prolonged aortic cross-clamping, CPB, and circulatory arrest.
  • The two-incision strategy significantly reduces intensive care unit and hospital lengths of stay compared to simultaneous sternotomy repair.
Abstract

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