Outcome following single-stage repair of coarctation with ventricular septal defect

Objective: A recent multi-institutional study suggested improved survival ( 97%) after staged repair of coarctation with ventricular septal defect (VSD ) compared with single-stage repair. The current study was undertaken to de termine outcome and need for reintervention following single-stage repair o f coarctation and VSD at our institution. Methods: Retrospective review of patients undergoing single-stage repair of coarctation with VSD between Oct ober 1, 1994 and August 15, 1999. Results: Single-stage repair of coarctati on with VSD was performed in 25 infants (12 males, 13 females) at a median age of 12 days (range 1-87 days) and median weight of 3.3 kg (range 1.3-4.4 kg). The VSD was conoventricular in ten patients, malalignment type with p osterior deviation of the infundibular septum in ten, muscular in four and conal septal hypoplasia in one. Arch hypoplasia was present in all patients and bicuspid aortic valve in 13. At least moderate subaortic narrowing was present in six patients (secondary to prolapse of tricuspid valve tissue a cross the VSD in four). Repairs were performed via a median sternotomy with a mean circulatory arrest time of 38 +/- 12 min. Overall patient survival was 96% with one operative death and no late deaths at a median follow-up o f 16 months (range 1-50 months). Reinterventions included balloon dilatatio n of recurrent coarctation (five), closure of residual VSD (one) and Ross-K onno procedure (two). Actuarial freedom from reintervention for the hospita l survivors was 81% (95% confidence limit (CL) 61%, 92%) at 6 months, 71% ( 95% CL 47%, 87%) at 1 year and 59% (95% CL 31%, 82%) at 2 years following s urgery. Conclusion: Single-stage repair of coarctation with VSD can be perf ormed with low operative mortality and good midterm survival equivalent to reported results for staged repair. (C) 2000 Elsevier Science B.V. All righ ts reserved.