Single-stage repair for coarctation with ventricular septal defect: results of 100 cases at a single centre

• Published in: Interactive cardiovascular and thoracic surgery 2020-10, Vol.31 (4), p.559-564
• Main Authors: Truong, Nguyen Ly Thinh, Mai, Nguyen Tuan, Vinh, Tran Quang, Anh, Doan Vuong, Duyen, Mai Dinh
• Format: Article
• Language: English
• Subjects: Aortic Coarctation - mortality; Aortic Coarctation - surgery; Cardiac Surgical Procedures - methods; Female; Heart Septal Defects, Ventricular - mortality; Heart Septal Defects, Ventricular - surgery; Hospital Mortality - trends; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Survival Rate - trends; Treatment Outcome; Vietnam - epidemiology
• ISSN: 1569-9285; 1569-9285
• DOI: 10.1093/icvts/ivaa148

Abstract 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. Single-stage repair for coarctation of the aorta (CoA) or aortic arch hypoplasia (AAH) with ventricular septal defect (VSD) via the median sternotomy approach has now become a common surgical option at many institutions [1–3].