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31st Annual Meeting Abstracts: Early results of single-stage biventricular repair of severe aortic hypoplasia or atresia with ventricular septal defect and an adequate left ventricle
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P22. Early results of single-stage biventricular repair of severe aortic hypoplasia or atresia with ventricular septal defect and an adequate left ventricle
P. J. Gruber1, K. Cleaver2, I. Abdullah1, S. Fuller1, G. Wernovsky1, S. C. Nicolson1, J. W. Gaynor1, T. L. Spray1. 1Children's Hospital of Philadelphia, Philadelphia, PA, 2Vanderbilt University School of Medicine, Nashville, TN,
Objectives: Biventricular repair of aortic atresia (or severe aortic hypoplasia) is possible in the presence of a ventricular septal defect an adequate left ventricle, and a normal mitral valve. We asked the question if single stage Yasui repair was a safe alternative in all cases, even in the presence of interrupted aortic arch.
Methods: This is a retrospective analysis of all patients who underwent a Yasui procedure consisting of a combination Norwood reconstruction of the aortic arch, VSD closure to both semilunar roots, and conduit placement from right ventricle to pulmonary arteries.
Results: Between 1/95 and 1/05, 21 patients underwent single stage Yasui repair at a median age of 5 days and a median weight of 3.0 kg. Aortic atresia was present in 7 with aortic stenosis in 14, 11 with interrupted aortic arch. All patients with aortic stenosis had valvular diameters less than 3 mm. Median DHCA time was 55 minutes, aortic cross-clamp time was 56 minutes, and total support time was 98 minutes. Hospital survival for was 100%. Echocardiography in 19 patients demonstrated no significant outflow tract obstruction. Total length of stay was a median of 18 days. At mid-term follow up there has been one late death and reoperation has been necessary in 8 patients.
Conclusion: The Yasui single-staged approach is a safe alternative to staged repair in all cases of aortic hypoplasia with VSD with in the face of an adequate left ventricle and mitral valve.
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