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Ann Thorac Surg 2004;78:1989-1993
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Primary Repair for Aortic Arch Obstruction Associated With Ventricular Septal Defect

Martin Kostelka, MD, PhDa,*, Thomas Walther, MD, PhDa, Imke Geerdts, MDb, Ardawan Rastan, MDa, Stefan Jacobs, MDa, Ingo Dähnert, MDb, Herbert Kiefer, MDc, Wilfried Bellinghausen, MDc, Friedrich W. Mohr, MD, PhDa

a Klinik für Herzchirurgie, Universität Leipzig, Herzzentrum, Leipzig, Germany
b Kinderkardiologie, Universität Leipzig, Herzzentrum, Leipzig, Germany
c Anästhesie, Universität Leipzig, Herzzentrum, Leipzig, Germany

Accepted for publication May 6, 2004.

* Address reprint requests to Dr Kostelka, Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Strümpellstr 39, 04289 Leipzig, Germany
kostelm{at}medizin.uni-leipzig.de

BACKGROUND: The aim of the present study was to evaluate the current outcome and reoperation rate after applying a one-stage correction strategy for interrupted aortic arch (IAA) with ventricular septal defect (VSD) and also for aortic coarctation and hypoplastic aortic arch (CoA-HyAA) with VSD beginning September 1999.

METHODS: Twenty-four consecutive patients with IAA (n = 12) or CoA-HyAA (n = 12) with VSD underwent early one-stage correction. Patients' mean age was 12 days (range, 2 to 188); mean weight was 3.6 kg (range, 2.1 to 7.3), 6 patients were less than 2.5 kg. Three IAA were type A, 5 type B1, 3 type B2, and 1 type C. Associated anomalies included a large VSD in all, left ventricular outlet tract obstruction in 5, transposition of the great arteries, aortopulmonary window, persistent truncus arteriosus, and double-outlet right ventricle in 1 patient. Selective brain perfusion through innominate artery and selective coronary perfusion through aortic root during aortic arch reconstruction was used in all patients. Mean follow-up was 2.2 ± 0.9 years.

RESULTS: There was no early, no late mortality, and no postoperative neurologic complications. Mean crossclamp duration was 72 ± 32 minutes, lowest temperature 22.8 ± 4°C and selective brain and coronary perfusion duration was 34 ± 13 minutes. Eighteen patients required delayed sternal closure at 1.7 days postoperatively. New perioperative management reduced the overall morbidity. Four patients after IAA plus VSD repair developed aortic arch restenosis and were successfully treated by balloon dilatation. One patient with d-TGA underwent right ventricular outflow tract reconstruction of right ventricular outlet tract obstruction 7 months after the initial repair. Pressure gradients across the anastomosis at most recent follow up were less than 10 mm Hg. All patients are asymptomatic and are developing normally.

CONCLUSIONS: One-stage complete correction is feasible in newborns with aortic arch obstruction with VSD. Complex cardiac anatomy presents no additional risk for the procedure. The early one-stage correction yields excellent surgical results and good functional outcome.


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