Single-Stage Repair of Coarctation of the Aorta and Ventricular Septal Defect in Infants Younger than 6 Months / 대한흉부외과학회지

ABSTRACT

BACKGROUND: The optimal therapeutic strategies for patients with coarctation of the aorta(CoA) and ventricular septal defect(VSD) remain controversial. This study was undertaken to determine the outcome and the need for reintervention following single-stage repair of coarctation with VSD in infants younger than 6 months. MATERIAL AND METHOD: Thirty three consecutive patients who underwent single-stage repair of CoA with VSD, from January 1995 to December 2000, at Sejong General Hospital were reviewed retrospectively. Mean age and body weight at repair were 54+/-37 days(12 days-171 days) and 3.9+/-1.1 kg(1.5~6 kg), respectively. The surgical repair of CoA was performed under deep hypothermic circulatory arrest(CA) in the early period of the study and under regional cerebral perfusion through a direct innominate arterial cannulation without CA in the later period. The technique used in the repair of the CoA was resection and extended end-to-end anastomosis(EEEA; n=16) and extended side-to-side anastomosis(ESSA; n=2) in the early period, and resection and extended end-to-side anastomosis(EESA; n=15) in the later period. The simultaneous closure of VSD was done with a Dacron patch(n=16) and autologous pericardium(n=17). Aortic arch hypoplasia was present in 29 patients(88%) and its types were distal(n=18), complete(n=5), and complex(n=6). RESULT: All procedures without CA were performed in 18 patients(55%) and repair of CoA without CA in 20 patients(61%). The total bypass and aortic crossclamp time were 163+/-68 minutes and 52+/-27 minutes, respectively, and the mean time used for CA was 27+/-11 minutes. There were four early postoperative deaths(12.1%). Twenty nine hospital survivors were followed up for a mean of 38+/-26 months(6 months-78 months) and recurrent coarctation has occurred in 5 patients(17.2%). Two patients underwent balloon aortic angioplasty for recurrent coarctation and the need for reoperation was not present. Actuarial freedom from recoarctation at 1 and 4 years were 85% and 78%, respectively. Actuarial freedom from recoarctation at 4 years was 92% after EESA and 77% after EEEA(p=NS). There was no late death. CONCLUSION: Single-stage repair of aortic coarctation and VSD using extended anastomosis can be performed with the acceptable operative mortality and provides adequate correction of coarctation and low risk of recoarctation.