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What is the optimal management of infants with coarctation and ventricular septal defect?
Annals of Thoracic Surgery 2007 August
BACKGROUND: The management of patients with aortic coarctation and ventricular septal defect (VSD) remains controversial. We reviewed our experience with coarctation and VSD from 2002 to 2006.
METHODS: Three approaches were used to manage 36 consecutive infants with coarctation and VSD. Group I had staged coarctation repair with or without pulmonary artery banding, followed by VSD closure with two separate operations (two-stage, n = 11); Group II had coarctation repair and VSD closure on cardiopulmonary bypass (CPB) with circulatory arrest or regional perfusion during coarctation repair (one-stage, one-incision, n = 10); Group III had coarctation repair without CPB through a thoracotomy, followed by VSD closure during the same operation (one-stage, two-incisions, n = 15).
RESULTS: No patients died. One recoarctation occurred in group II. Group II had significantly longer times for CPB (135.6 +/- 31.8 versus 94.3 +/- 29.8 minutes for group I; 67.6 +/- 16.7 minutes for group III; p < 0.001) and combined regional perfusion/circulatory arrest (30.0 +/- 17.0 versus 5.3 +/- 11.9 minutes for group I, 1.1 +/- 4.4 minutes for group III, p < 0.0001). Group III compared with group II had significantly shorter lengths of stay in the intensive care unit (119.5 +/- 64.8 versus 220.8 +/- 198.8 hours, p = 0.04) and hospital (8.4 +/- 3.8 versus 24.4 +/- 24.4 days, p = 0.01). Combining values for the two hospitalizations in the group I infants, lengths of stay in the intensive care unit (178.8 +/- 70.8 hours) and hospital (20.5 +/- 11.6 days) were intermediate between groups II and III.
CONCLUSIONS: Primary repair of infants with coarctation and VSD using a one-stage approach through separate incisions affords excellent clinical results. One can avoid prolonged aortic cross-clamping, CPB, and circulatory arrest/regional perfusion. Compared with the group undergoing combined coarctation and VSD repair simultaneously by sternotomy, total lengths of stay in the intensive care unit and hospital were significantly decreased.
METHODS: Three approaches were used to manage 36 consecutive infants with coarctation and VSD. Group I had staged coarctation repair with or without pulmonary artery banding, followed by VSD closure with two separate operations (two-stage, n = 11); Group II had coarctation repair and VSD closure on cardiopulmonary bypass (CPB) with circulatory arrest or regional perfusion during coarctation repair (one-stage, one-incision, n = 10); Group III had coarctation repair without CPB through a thoracotomy, followed by VSD closure during the same operation (one-stage, two-incisions, n = 15).
RESULTS: No patients died. One recoarctation occurred in group II. Group II had significantly longer times for CPB (135.6 +/- 31.8 versus 94.3 +/- 29.8 minutes for group I; 67.6 +/- 16.7 minutes for group III; p < 0.001) and combined regional perfusion/circulatory arrest (30.0 +/- 17.0 versus 5.3 +/- 11.9 minutes for group I, 1.1 +/- 4.4 minutes for group III, p < 0.0001). Group III compared with group II had significantly shorter lengths of stay in the intensive care unit (119.5 +/- 64.8 versus 220.8 +/- 198.8 hours, p = 0.04) and hospital (8.4 +/- 3.8 versus 24.4 +/- 24.4 days, p = 0.01). Combining values for the two hospitalizations in the group I infants, lengths of stay in the intensive care unit (178.8 +/- 70.8 hours) and hospital (20.5 +/- 11.6 days) were intermediate between groups II and III.
CONCLUSIONS: Primary repair of infants with coarctation and VSD using a one-stage approach through separate incisions affords excellent clinical results. One can avoid prolonged aortic cross-clamping, CPB, and circulatory arrest/regional perfusion. Compared with the group undergoing combined coarctation and VSD repair simultaneously by sternotomy, total lengths of stay in the intensive care unit and hospital were significantly decreased.
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