Decision making for the surgical management of aortic coarctation associated with ventricular septal defect

Coarctation of the aorta and associated ventricular septal defect may be repaired simultaneously or by initial coarctation repair with or without banding of the pulmonary artery. The question is whether specific preoperative criteria can enable the surgeon to choose the optimal surgical management....

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 1996, Vol.111 (1), p.168-175
Main Authors: Brouwer, René M.H.J., Cromme-Dijkhuis, Adri H., Erasmus, Michiel E., Contant, Caroline, Bogers, Ad J.J.C., Elzenga, Nynke J., Ebels, Tjark, Eijgelaar, Anton
Format: Article
Language:English
Subjects:
Aortic Coarctation - complications
Aortic Coarctation - epidemiology
Aortic Coarctation - surgery
Biological and medical sciences
Cardiology. Vascular system
Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava
Female
Follow-Up Studies
Heart
Heart Septal Defects, Ventricular - complications
Heart Septal Defects, Ventricular - epidemiology
Heart Septal Defects, Ventricular - surgery
Hospital Mortality
Humans
Infant
Infant, Newborn
Male
Medical sciences
Probability
Recurrence
Retrospective Studies
Risk Factors
Survival Analysis
Time Factors
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Summary:Coarctation of the aorta and associated ventricular septal defect may be repaired simultaneously or by initial coarctation repair with or without banding of the pulmonary artery. The question is whether specific preoperative criteria can enable the surgeon to choose the optimal surgical management. Between 1980 and 1993, 80 infants younger than 3 months with coarctation and ventricular septal defect were treated surgically. In 64 infants (multistage group), simple coarctation repair was performed through a posterolateral approach, with concomitant banding of the pulmonary artery in 10 infants. Twenty ventricular septal defects were closed as a secondary procedure and four were closed as a tertiary procedure. Sixteen infants (single-stage group) underwent one-stage repair through an anterior midline approach. The total in-hospital mortality rate was 7.5%. Freedom from recoarctation after 5 years was 91.3% in the multistage group versus 60.0% in the single-stage group ( p = 0.018). Freedom from secondary ventricular septal defect treatment in the multistage group after 5 years was 40.7%, versus 100% in the single-stage group ( p = 0.016). Thirty-seven ventricular septal defects (47.8%) closed spontaneously. In particular, the preoperative left-to-right shunt and extension of the perimembranous VSD into the inlet or outlet were risk factors for the need for eventual surgical ventricular septal defect closure after initial coarctation repair. On the basis of these two risk factors, the probability of the need for eventual surgical treatment of ventricular septal defect after initial coarctation repair can be calculated. This policy offers a well-considered choice between single-stage and multistage repair, weighing the risk of secondary ventricular septal defect treatment versus the risk of recoarctation. Finally, the number of surgical procedures per infant will be as low as possible. (J T HORAC C ARDIOVASC S URG 1996;111:168-75)
ISSN:0022-5223
1097-685X
DOI:10.1016/S0022-5223(96)70413-0