Single-stage repair of aortic arch obstruction and associated intracardiacdefects with pulmonary homograft patch aortoplasty

Objective: Intracardiac malformations associated with coarctation and aorti c arch hypoplasia have traditionally been repaired in 2 stages, with a high mortality rate, We review our experience with single-stage biventricular r epair of intracardiac defects associated with aortic arch hypoplasia by mea ns of pulmonary homograft patch aortoplasty, Methods: Between October 1988 and October 1997, 39 of 40 consecutive patients underwent single-stage bive ntricular repair for aortic arch obstruction and associated intracardiac de fects. The median age at operation was 17 days and the mean weight was 3.71 +/- 1.09 kg, Nineteen patients had either dextrotransposition of the great arteries or the Taussig-Bing anomaly. Sixteen patients had multiple left-s ided obstructive lesions (2 cases of critical aortic stenosis, 3 of subaort ic stenosis and ventricular septal defect, and 11 of hypoplastic left heart complex), One patient had an associated complete atrioventricular septal d efect. Four patients had only an associated ventricular septal defect. Thro ugh a median sternotomy, the hypoplastic aortic arch was enlarged with a pu lmonary homograft patch in 36 patients. In 4 patients an extended end-to-en d anastomosis was performed. Results: There were 2 early deaths (5%) and 2 late deaths (5%). One late death was not cardiac related. The mean follow-u p time was 36 months (range 1 month-9 Sears). The recoarctation rate after pulmonary homograft patch aortoplasty was 8.3%, but after exclusion of thos e patients with associated left-sided obstructive lesions this decreased to 0%. No aneurysm formation in the aorta has occurred. The actuarial surviva l at 8 years is 89% +/- 10%. Conclusions: Single-stage biventricular repair of aortic arch obstruction and associated intracardiac defects can achieve excellent survival. We recommend pulmonary homograft patch aortoplasty bec ause it achieves complete relief of anatomic afterload with a tension-free anastomosis and low incidence of recoarctation.