Interim Results of Single Stage Operation for Coarctation of Aorta with Large Ventricular Septal Defect in Infancy

ABSTRACT

PURPOSE: There are controversies in the operative methods of aorta with ventricular septal defect in infancy. Recent results of single stage operation for coarctation of aorta with intracardiac defects were regarded as comparable to staged operation. We evaluated our interim results after single stage operation for coarctation of aorta with large ventricular septal defect in infancy. METHODS: Twenty six infants who had received single stage operation for coarctation of aorta with large ventricular septal defect between January 1989 and December 1994 were analyzed retrospectively. Evaluated variables were age and weight at operation, type of ventricular septal defect, absence or presence of left ventricular outflow tract obstruction, aortic cross clamping time, total circulatory arrest time, methods of coarctoplasty, operative mortality rate, complications and cardiovascular abnormalities on follow up. RESULTS: Age and weight at operation were 2.8+/-2.6 months and 4.0+/-1.2kg respectively. Perimembranous ventricular spetal defect was most common (15 cases; 57.7%). Twelve cases (46.2%) had left ventricular outflow tract obstruction. Aortic cross clamping time was 65.6+/-12.1 minutes and total circulatory arrest time was 51.7+/-14.6 minutes. Coarctation of aorta was corrected with extended resection and end-to-end anastomosis in 23 cases and patch aortoplasty in 3 cases. Among 12 cases of left ventricular outflow tract obstruction, 8 cases received correction and only 1 case of other 4 cases showed significant obstruction on follow up. Early mortality rate was 19.2% (5 cases) and all others survived for the follow up period of 33.5+/-16.6 months. Early complication rate was as high as 71.4% (15 cases), even though all except 3 cases of hypoxic encephalopathy resolved. Statistically significant operative risks were age and weight at operation, especially in cases under 2 month of age and 4.0kg. Aortic cross clamping time and total circulatory arrest time was somewhat longer in expired group, although it was statistically not significant. CONCLUSIONS: Operative mortality rate of single stage operation for coarctation of aorta with large ventricular septal defect in infancy during the study period was not low. In this study, the age and weight at operation was significant factors associated with mortality. However, the results of single stage operation could be improved in case of proper selection of candidates and after some learing period.