SINGLE-STAGE REPAIR OF AORTIC-ARCH OBSTRUCTION AND ASSOCIATED INTRACARDIAC DEFECTS IN THE NEONATE

The effectiveness of a single-stage anterior approach for the repair o f aortic arch obstruction and associated intracardiac defects has not been well evaluated. We therefore reviewed our experience with 60 neon ates (median age 8 days, range 1 to 28) who underwent a single-stage r epair by way of a median sternotomy at our institution between 1986 an d 1994. Nineteen (32%) had coarctation with ventricular septal defect, 18 (30%) had interrupted aortic arch with ventricular septal defect, and 23 (38%) had coarctation or interrupted aortic arch with complex i ntracardiac anatomy. The arch obstruction was repaired using resection and primary anastomosis in 54 patients, synthetic patch aortoplasty i n 3, subclavian flap aortoplasty in 2, and an interposition gortex gra ft placement in 1. Total circulatory arrest time was 48 +/- 3 minutes (mean +/- SEM). There were 7 early postoperative deaths (11.7%; 70% co nfidence limit 8% to 16.6%). The 53 survivors were followed for a mean of 23 months (range 1 to 78), for a total of 1,219 patient-months. Re current arch obstruction greater than or equal to 20 mm Hg has occurre d in 2 of 53 patients (3.8%; 70% confidence limit 1.9% to 7.5%); both underwent successful balloon angioplasty. There were 2 late deaths, 1 of which was noncardiac. We conclude chat repair of aortic arch obstru ction and intracardiac defects by a single-stage approach through medi an sternotomy can be accomplished with low mortality in infancy, even with associated cardiac anatomy. Recurrent coarctation is common and c an be successfully managed with angioplasty.