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Ann Thorac Surg 2008;86:352. doi:10.1016/j.athoracsur.2008.01.009
© 2008 The Society of Thoracic Surgeons
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Correspondence

Surgical Strategy in the Treatment of Neonates With Aortic Coarctation and Associated Ventricular Septal Defects

Onur S. Goksel, MD, Emin Tireli, MD

University of Istanbul, Istanbul Medical Faculty, Department of Cardiovascular Surgery, 4. Gazeteciler Sitesi, C3 Blok, Da: 161. Levent, Istanbul, 80620 Turkey

(Email: onurgokseljet{at}gmail.com).

To the Editor:

We read with the greatest interest the article by Alsoufi and colleagues [1] on the surgical strategies in the treatment of neonates with aortic coarctation and interruption and associated ventricular septal defects. Alsoufi and coworkers [1] analyzed their surgical results with 141 consecutive patients who underwent either staged or simultaneous surgery for neonatal aortic coarctation associated with ventricular septal defects (VSDs) during a 16-year period of time. We would like to congratulate the authors for their favorable results with 1-year survival of 92% ± 2% and overall survival of 90.8% ± 2% at 10 years. They emphasized the significance of the type and size of ventricular septal defect for the surgical approach. As the authors suggested, our group performs combined surgery unless spontaneous ventricular septal defect closure is anticipated. In cases when an extensive arch reconstruction is required, an off-pump technique is still preferred whenever possible [2, 3]. We do not routinely apply deep hypothermic circulatory arrest; we rather use selective antegrade cerebral perfusion as Shino and coworkers [4] suggested when proximal arch is also hypoplastic or ductal-dependent circulation is the case, or both. With this approach, avoidance from deep hypothermic circulatory arrest is possible during a combined approach for arch reconstruction and the repair of the intracardiac pathology in the neonate. In our experience, almost half of aortic arch pathologies can be repaired with an off-pump technique through a sternotomy, later proceeding with a shorter period of cardiopulmonary bypass for the intracardiac repair.

We would like to congratulate the authors for assesment of their results in a practical manner to determine the type of surgery.


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  1. Alsoufi R, Cai S, Coles JG, et al. Outcomes of different surgical strategies in the treatment of neonates with aortic coarctation and associated ventricular septal defects Ann Thorac Surg 2007;84:1331-1337.[Abstract/Free Full Text]
  2. Ozkara A, Cetin G, Tireli E, et al. Off pump repair of aortic arch anomalies with concomitant intracardiac defects via anterior approach J Card Surg 2006;21:550-552.[Medline]
  3. Cetin G, Tireli E, Ozkara A, et al. Aortic arch reconstruction with pulmonary autograft patch in coarctation and interruption of the aorta J Card Surg 2005;20:167-170.[Medline]
  4. Shino K, Kawada M, Irie H, Kino K, Sano S. Single-stage repair of aortic coarctation with ventricular septal defect using isolated cerebral and myocardial perfusion Eur J Cardiothorac Surg 2000;17:538-542.[Abstract/Free Full Text]

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Bahaaldin Alsoufi and Christopher A. Caldarone
Ann. Thorac. Surg. 2008 86: 352-353. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., July 1, 2008; 86(1): 352 - 353.
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