Transmediastinal repair of complex coarctation and interrupted aortic arch

In the past 2 years, eight patients have had repair of coarctation of the aorta or interrupted aortic arch along with an intracardiac procedure performed through a simple midsternotomy. Five underwent total repair and three had palliation for the intracardiac lesion. Four patients did well (including one who required a resection for recoarctation), two died intraoperatively, and two died postoperatively (11 and 21 days), one of them from clostridial sepsis and the other from cerebral anoxia that followed a cardiac arrest precipitated by a massive hemoptysis. We found that with this approach the aortic obstruction could be readily relieved and the intracardiac procedure carried out. Since the majority of these patients have compromised hemodynamic status, the ease of instituting immediate bypass, avoidance of a separate incision, and feasibility of total repair are major advantages.