Single-stage off-pump repair of coarctation of the aorta and ventricular septal defects in children.

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.