Single-stage off-pump repair of coarctation of the aorta and ventricular septal defects in children
Abstract OBJECTIVES The appropriate approach for surgical repair of coarctation of the aorta with a ventricular septal defect (VSD) remains controversial. This study evaluated the outcomes of primary repair of VSDs with periventricular device closure without cardiopulmonary bypass through a left tho...
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Published in | Interactive cardiovascular and thoracic surgery Vol. 35; no. 2 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford University Press
09.07.2022
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Subjects | |
Online Access | Get full text |
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Summary: | Abstract
OBJECTIVES
The appropriate approach for surgical repair of coarctation of the aorta with a ventricular septal defect (VSD) remains controversial. This study evaluated the outcomes of primary repair of VSDs with periventricular device closure without cardiopulmonary bypass through a left thoracotomy in patients without arch hypoplasia.
METHODS
We selected 21 patients aged <1 year, including 7 neonates, who underwent repair of coarctation of the aorta with periventricular device closure of a VSD.
RESULTS
The median occluder size was 6 (range, 5–8) mm. The median mechanical ventilation time was 14 (range, 2–68) h, and the median duration of hospital stay was 11 (range, 7–16) days. No reoperations were required to correct VSD shunting, and the median residual shunt size was 1 (range, 1–2) mm. The median follow-up period was 13 (range, 4–31) months. No late deaths were reported, and no haemodynamically significant pressure gradient at the anastomotic site was observed. The median distal aortic arch z-score was 0.39 (range, −0.1–to 0.9). Only 1 patient had a permanent pacemaker implanted towards the end of the follow-up period.
CONCLUSIONS
Periventricular device closure can be used safely for closure of VSD in children with coarctation of the aorta without a hypoplastic aortic arch, even in neonates, to reduce the risk of prolonged cardiopulmonary bypass. This hybrid approach can be performed with a low incidence of rhythm disturbances and residual shunting. However, a meticulous assessment of the VSD anatomy is essential to avoid any unfavourable events.
Coarctation of the aorta (CoAo) is frequently associated with septal defects in neonates and infants. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Meeting presentation: The abstract was submitted for the 33rd EACTS annual meeting in Lisbon. |
ISSN: | 1569-9285 1569-9293 1569-9285 |
DOI: | 10.1093/icvts/ivac186 |