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Single-stage repair for coarctation with ventricular septal defect: results of 100 cases at a single centre
Nguyen Ly Thinh Truong1, Nguyen Tuan Mai1, Tran Quang Vinh1
1Department of Cardiovascular Surgery, Children Heart Center, National Children's Hospital, Hanoi, Vietnam.
Insights
Single-stage surgical repair for aortic arch hypoplasia (AAH) and coarctation of the aorta (CoA) with ventricular septal defect (VSD) demonstrated high survival rates. This approach is safe and feasible, even in developing countries.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Outcomes of single-stage repair for complex congenital heart defects like aortic arch hypoplasia (AAH) and coarctation of the aorta (CoA) with ventricular septal defect (VSD) are debated, particularly in resource-limited settings.
- Selective cerebral perfusion is a critical technique in managing these complex cases.
Purpose of the Study:
- To evaluate the safety and efficacy of a single-stage surgical repair protocol for AAH/CoA with VSD using selective cerebral perfusion.
- To assess outcomes in a lower middle-income country context.
Main Methods:
- Retrospective analysis of 100 consecutive patients undergoing single-stage repair for AAH/CoA with VSD between July 2010 and March 2017.
- Utilized median sternotomy and selective cerebral perfusion during cardiopulmonary bypass.
Main Results:
- Achieved an overall survival rate of 94.7% with 5% in-hospital mortality and no late mortality at a median follow-up of 37 months.
- Four patients (4%) required reoperation for recoarctation; overall event-free survival was 87.1%.
- Proximal aortic arch obstruction predicted mortality (OR=3.8), while aortic isthmus diameter predicted reintervention (HR=6.7).
Conclusions:
- Single-stage repair for AAH/CoA with VSD is a safe and feasible surgical strategy.
- The protocol is effective even in developing countries, offering a viable treatment option for complex congenital heart disease.
Objectives:
The outcomes of the single-stage surgical repair of aortic arch hypoplasia (AAH) and/or coarctation of the aorta (CoA) associated with ventricular septal defect (VSD) remain controversial, especially in a lower middle-income country. This study reports the results of a single-stage repair protocol at our institution for AAH/CoA with VSD using selective cerebral perfusion.
Methods:
This retrospective study included 100 consecutive patients who underwent single-stage repair via median sternotomy using selective cerebral perfusion for AAH/CoA with VSD from July 2010 to March 2017.
Results:
The patients consisted of 65 males and 35 females. The median age of the patients was 67 days (range 4-2266 days); the median weight was 3.8 kg (range 2.1-15 kg). The average cardiopulmonary bypass time was 132 ± 28 min, the aortic cross-clamp time was 92 ± 23 min and the selective cerebral perfusion time was 33 ± 10 min. The survival rate of all patients was 94.7 ± 2.3%, with an in-hospital mortality of 5% and no late mortality at a median follow-up of 37 months (range 4-96 months). Four patients required reoperation due to recoarctation. The overall event-free survival rate following surgery was 87.1%. The median pressure gradient across the anastomosis at the last follow-up was 8.3 ± 2.8 mmHg. Multivariate logistic regression analysis revealed proximal aortic arch obstruction as a predictor of mortality (odds ratio = 3.8). The aortic isthmus diameter was identified as a predictor for reintervention by Cox regression (hazard ratio = 6.7).
Conclusions:
Single-stage repair for AAH/CoA with VSD is safe and feasible in a developing country.
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