Management of an associated ventricular septal defect at the time of coarctation repair

Background. Management of a ventricular septal defect(VSD) at time of coarctation of the aorta (CoA) repairremains controversial, with recent studies advocatingconcomitant repair of both defects. We evaluated thesurgical management and mortality for patients undergoingCoA repair associated with a VSD.

Methods. We retrospectively reviewed data submittedto the Pediatric Cardiac Care Consortium of patients undergoingrepair of CoA from 1982 to 2007. The cohort wasdivided into three groups: CoA repair plus VSD closure(group 1); CoA repair plus pulmonary artery band (group2); and CoA repair without repair of VSD (group 3).Variables reviewed included era, age, and weight atrepair, and in-hospital mortality.

Results. Therewere 7,860patientswhounderwent repairof CoA, of whom 2,022 had an associated VSD (25.7%).Mortality after CoA repair with and without an associateddiagnosis ofVSDwas 8.3%versus 2.1%(-rfpag< 0.001).Meanageat repair for group 1 (n [ 286) and group 2 (n [ 472) was87.4 days and21.6days, respectively (p[0.004), andmedianweight was 3.31 kg and 3.30 kg, respectively (p [ 0.130).Discharge mortality for group 1 and group 2 was similar,at 8.7% and 9.1%, respectively (p [ 0.852). Patients withCoA/VSD who had neither VSD closure nor pulmonaryartery banding (group 3) had a hospital mortality of 7.9%.

Conclusions. The association of CoA and VSD iscommon. A strategy of concomitant VSD closure at CoArepair does not result in worse discharge mortality whencompared with pulmonary banding with anticipatedstaged repair of the VSD. These outcomes supportcontinued evaluation of a one-stage approach.