Single Stage Repair of Aortic Coarctation with Intracardiac Anomalies via Median Sternotomy

Surgical strategy and approach are important in patients with aortic coarctation associated with intracardiac anomalies. In this study, surgical technique, indications and results of the single stage repair of aortic coarctation and intracardiac defects via median sternotomy were discussed. Between January 1987 and August 2002, 158 patients with aortic coarctation or interrupted aortic arch (IAA) underwent surgery. In 17 of them who had associated intracardiac anomalies, single stage approach via median sternotomy were performed. Their ages ranged from 1 month to 13 years (mean 2.2 ± 3.3 years). Ventricular septal defect (VSD) and aortic stenosis were the most common associated lesions. Aortic coarctation was repaired under cardiopulmonary bypass initially and then intracardiac repair was performed. A short period of total circulatory arrest was necessary in two patients with IAA and one patient with extensive arcus hypoplasia. Among the patients who underwent single stage repair of aortic coarctation and intracardiac anomalies,a two month old baby with interrupted aortic arch, VSD and pulmonary hypertension died due to septicemia (5,8 %). Long period of ventilatory support was needed in one patient. One patient underwent reoperation due to severe residual coarctation gradient at the postoperative second month. Single stage repair via median sternotomy can be performed with low mortality and morbidity in patients with aortic coarctation and intracardiac anomalies. According to our opinion this approach should be the procedure of choice, because it is a safe and cost effective method. Also the patients can be avoided from the hazards of recurrent procedures.