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Ann Thorac Surg 1999;67:751-755
© 1999 The Society of Thoracic Surgeons

Original Articles

Aortic atresia with a ventricular septal defect: modified single-stage neonatal biventricular repair

Michael D. Black, MDa, Jeffery F. Smallhorn, MDb, Robert M. Freedom, MDb

a Division of Cardiovascular Surgery, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
b Division of Cardiology, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada

Accepted for publication July 30, 1998.

Address reprint requests to Dr Black, Division of Cardiovascular Surgery, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Stanford, CA 94305-5407
e-mail: michael.black{at}stanford.edu

Background. The spectrum of hypoplastic left heart disease is diverse but the surgical repair is strictly dichotomous, culminating in either a univentricular or a biventricular surgical repair. Although aortic atresia with a ventricular septal defect historically has been managed by conversion to a univentricular physiology, a biventricular repair occasionally has been attempted in stages or in conjunction with the implantation of multiple allografts or prosthetic conduits. Our repair strategy recently has evolved to the use of a modified single-stage biventricular repair using only autologous tissues without conduits.

Methods. Retrospective analysis (1989 to 1997) of neonates with aortic atresia with a ventricular septal defect.

Results. Five neonates underwent repair of aortic atresia with a ventricular septal defect. One died in the hospital. The mean age and weight of the neonates who underwent repair were 7.8 days (range, 2 to 17 days) and 3.2 kg (range, 3 to 3.6 kg), respectively. Three neonates had a univentricular repair and 2 had a modified biventricular repair. The latter two procedures were successful and the patients were discharged from the hospital.

Conclusions. Long-term results are lacking to attest to this surgical modification’s superiority over either the standard multistage univentricular operation or the single-stage biventricular repair using multiple conduits. However, we are optimistic that routine use of this modification will enable a greater percentage of neonates to undergo a biventricular repair without the need for serial conduit revisions or future aortoplasty.




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