HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bahaaldin Alsoufi Christopher A. Caldarone Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Alsoufi, B. Articles by Caldarone, C. A. Search for Related Content PubMed Articles by Alsoufi, B. Articles by Caldarone, C. A. Related Collections Related Article

---

Correspondence

Reply

^a King Faisal Heart Institute (MBC 16), King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi Arabia
^b The Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, Ontario, M5G 1X8 Canada

(Email: balsoufi{at}hotmail.com; christopher.caldarone{at}sickkids.ca).

To the Editor:

We thank Drs Goksel and Tireli [1] for their input. It was interesting to learn about their off-pump technique in repairing coarctation of the aorta (COA) through a sternotomy [2]. In light of our findings [3] and their experience, the following strategies seem appropriate in a neonate with COA and a ventricular septal defect (VSD) that is unlikely to close spontaneously:

1 If the proximal arch is of adequate size with hypoplasia limited to the isthmus area and the distal arch, all of the following options are acceptable: two-stage, two-incision strategy of COA repair through a left thoracotomy followed later by VSD closure through a sternotomy [3, 4]; single-stage, two-incision strategy of COA repair through a left thoracotomy followed immediately by VSD closure through a sternotomy [4]; and single-stage, single-incision strategy with simultaneous closure of VSD and repair of COA through a sternotomy [2–4]. Although the latter strategy has been traditionally performed with the use of cardiopulmonary bypass (CPB) support and deep hypothermic circulatory arrest (DHCA) [3, 4], the authors report their experience with a simultaneous off-pump arch repair through a sternotomy, followed by VSD closure using a short CPB duration without the use of DHCA [2]. The optimal strategy will be one that will provide a complete, single-stage repair, with fewer scars, less exposure to CPB and DHCA in the neonatal period, and shorter hospital and intensive care stay. It seems that their strategy may offer some advantage in comparison with other strategies, as it meets most of those objectives.

2 If the proximal arch is hypoplastic, it is likely that more extensive arch repair with the use of CPB and DHCA will be necessary, and extension of the arch incision into the ascending aorta is required to achieve adequate relief of arch obstruction [3, 4] . Therefore, an off-pump technique through a left thoracotomy or a sternotomy may not be a valid option in these cases. Our current policy is to use selective antegrade cerebral perfusion, although its benefit in comparison with DHCA has not been widely established [3, 5, 6].

In Goksel and Tireli's [1] article, 10 children between 5 days to 72 months of age underwent off-pump arch repair through a sternotomy with excellent operative and short-term results [2]. They report that they have been able to repair almost half of the aortic arch pathologies without the use of CPB. Similarly, in our experience, despite the fact that all our patients were neonates with a higher prevalence of arch hypoplasia, an off-pump COA repair through a left thoracotomy was possible, and it was adequate in more than 50% of the cases [3]. That indicates that an off-pump COA repair in neonates, through a left thoracotomy or a sternotomy, is a possible strategy in the armamentarium of the techniques on hand to the surgeon.

	References

Top References

 

1. Goksel OS, Tireli E. Surgical strategy in the treatment of neonates with aortic coarctation and associated ventricular septal defects(letters) Ann Thorac Surg 2008;86:352.[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. 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]
4. Kanter KR. Management of infants with coarctation and ventricular septal defect Semin Thorac Cardiovasc Surg 2007;19:264-268.[Medline]
5. Goldberg CS, Bove EL, Devaney EJ, et al. A randomized clinical trial of regional cerebral perfusion versus deep hypothermic circulatory arrest: outcomes for infants with functional single ventricle J Thorac Cardiovasc Surg 2007;133:880-887.[Abstract/Free Full Text]
6. Visconti KJ, Rimmer D, Gauvreau K, et al. Regional low-flow perfusion versus circulatory arrest in neonates: one-year neurodevelopmental outcome Ann Thorac Surg 2006;82:2207-2211.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bahaaldin Alsoufi Christopher A. Caldarone Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Alsoufi, B. Articles by Caldarone, C. A. Search for Related Content PubMed Articles by Alsoufi, B. Articles by Caldarone, C. A. Related Collections Related Article