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Ann Thorac Surg 1999;68:962-967
© 1999 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Staged surgical approach to neonates with aortic obstruction and single-ventricle physiology

^a Division of Cardiothoracic Surgery, University of California, Los Angeles Medical Center, Los Angeles, California, USA
^b Division of Pediatric Cardiology, University of California, Los Angeles Medical Center, Los Angeles, California, USA

Address reprint requests to Dr Laks, Division of Cardiothoracic Surgery, UCLA Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

Background. The surgical management of neonatal systemic outflow obstruction and complex single ventricle pathology is variable.

Methods. In 15 neonates (12 boys and 3 girls) with complex forms of single-ventricle pathology and aortic coarctation or interruption, an initial strategy of banding the pulmonary artery and repair of the obstruction from a left thoracotomy was undertaken.

Results. The median age at operation was 6 days (range 2 to 33 days) and the median weight was 3.3 kg (range 2 to 4.6 kg). There were no early deaths and one late death after the initial surgical palliation. Of the 14 survivors, 8 have undergone a bidirectional cavopulmonary anastomosis. The median age for bidirectional Glenn was 9.75 months (range 3.5 to 26 months). Seven infants have required Damus-Kaye-Stansel reconstruction for subaortic obstruction (one early death). The median age of the Damus-Kaye-Stansel procedure was 4 months (range 3 weeks to 9 months). Thirteen of 15 patients (87%) are alive and 6 have proceeded to a Fontan operation (median follow-up 68 months). A single failing Fontan required takedown to bidirectional Glenn and central shunt.

Conclusions. Our experience suggests that this high-risk subgroup of neonates with aortic obstruction and single-ventricle pathophysiology is safely managed by initial pulmonary artery banding palliation and repair of aortic obstruction. This strategy, careful surveillance, and early relief of subaortic stenosis can maintain acceptable anatomy and hemodynamics for later bidirectional Glenn and Fontan procedures.

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