Hybrid technique for treatment of short-segment coarctation associated with ventricular septal defect

Objective To assess the advantages and outcomes of hybrid technique for repairing coarctation(CoA), ventricular septal defect(VSD) through mid-term follow-ups. Methods A total of 32 selected patients with short-segment CoA/VSD without obvious patent ductus arteriosus(PDA) underwent one-stage complete repair with hybrid technique from January 2009 to June 2013. There were 24 boys and 8 girls with a mean age of(58.2±43.1)(15-190) days and a mean weight of(3.9±1.3)(1.9-7) kg. Twenty-nine patients underwent balloon dilatation in catherization laboratory while the remainder in operation room. The mean balloon size was 4-8(5.7±1.0) mm. The mean diameter of coarctation increased from(2.0±0.6) to(3.8±0.8) mm immediately after dilatation while the gradient pressure declined from(31.7±12.4) to(7.3±5.1) mmHg. Then all patients underwent open heart surgery with a mean duration of cardiopulmonary bypass at(49.8±14.9)(32-87) min and a mean duration of aortic clamp at(25.6±8.2)(18-41) min. Results The above hybrid technique was all successful without intraoperative mortality. There was no late mortality during a follow-up period of 1-63 months. Neither residual VSD nor pseudoaneurysm occurred. At 1 and 5 years post-operation, the freedom rates from aortic re-stenosis were 84.4% and 84.4% and the freedom rates from re-intervention 90.6% and 87.5% respectively. Three patients received re-balloon dilatation at 8, 12 and 13 months post-operation. Only there was one case of end-to-end anastomosis through left thoracotomy. And none had re-stenosis. Conclusions Hybrid technique has excellent outcomes in the treatment of short-segment CoA/VSD. And its incidence of aortic re-stenosis and re-intervention is acceptable during mid-term follow-ups. Furthermore, most cases of aortic re-stenosis may be successfully relieved by re-balloon dilatation. Key words: Aortic coarctation; Heart septal defects, ventricular; Cardiac surgical procedures; Balloon dilatation