Figure 2: Overall survival. OBJECTIVES The outcomes of the single-stage surgical repair of aortic arch hypoplasia (AAH) and/or coarctation of the aorta (CoA) associated with ventricular septal defect (VSD) remain controversial, especially in a lower middle-income country. This study reports the results of a single-stage repair protocol at our institution for AAH/CoA with VSD using selective cerebral perfusion. METHODS This retrospective study included 100 consecutive patients who underwent single-stage repair via median sternotomy using selective cerebral perfusion for AAH/CoA with VSD from July 2010 to March 2017. RESULTS The patients consisted of 65 males and 35 females. The median age of the patients was 67 days (range 4–2266 days); the median weight was 3.8 kg (range 2.1–15 kg). The average cardiopulmonary bypass time was 132 ± 28 min, the aortic cross-clamp time was 92 ± 23 min and the selective cerebral perfusion time was 33 ± 10 min. The survival rate of all patients was 94.7 ± 2.3%, with an in-hospital mortality of 5% and no late mortality at a median follow-up of 37 months (range 4–96 months). Four patients required reoperation due to recoarctation. The overall event-free survival rate following surgery was 87.1%. The median pressure gradient across the anastomosis at the last follow-up was 8.3 ± 2.8 mmHg. Multivariate logistic regression analysis revealed proximal aortic arch obstruction as a predictor of mortality (odds ratio = 3.8). The aortic isthmus diameter was identified as a predictor for reintervention by Cox regression (hazard ratio = 6.7). CONCLUSIONS Single-stage repair for AAH/CoA with VSD is safe and feasible in a developing country.

Background Mortality associated with the correction of congenital heart disease has decreased to approximately 2% in developed countries and major adverse events are uncommon. Outcomes in developing countries are less well defined. The World Database for Pediatric and Congenital Heart Surgery was utilized to compare mortality and adverse events in developed and developing countries. Methods A total of 16,040 primary procedures were identified over a two-year period. Centers that submitted procedures were dichotomized to low/middle income (LMI) and high income (HI) by the Gross National Income per capita categorization. Mortality was defined as any death following the primary procedure to discharge or 90 days inpatient. Multiple logistic regression models were utilized to identify independent predictors of mortality. Results Of the total number of procedures analyzed, 83% (n  =  13,294) were from LMI centers. Among all centers, the mean age at operation was 2.2 years, with 36% (n  =  5,743) less than six months; 85% (n  =  11,307) of procedures were STAT I/II for LMI centers compared with 77% (n = 2127) for HI centers ( P < .0001). Overall mortality across the cohort was 2.27%. There was a statistical difference in mortality between HI centers (0.55%) versus LMI centers (2.64%) ( P < .0001). After adjustment for other risk factors, the risk of death remained significantly higher in LMI centers (odds ratio: 2.36, 95% confidence interval: 1.707-3.27). Conclusion Although surgical expertise has increased across the globe, there remains a disparity with some outcomes associated with the correction of congenital heart disease between developing and developed countries. Further studies are needed to identify specific opportunities for improvement.

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Background: This study evaluates mortality and intermediate outcomes of the arterial switch operation (ASO) for transposition or Taussig-Bing anomaly with single sinus coronary artery (CA) anatomy in a high-volume cardiac program in Vietnam. Methods: We retrospectively reviewed and performed risk factor analysis pertaining to 41 consecutive patients who presented with single sinus CA anatomy and who underwent ASO from January 2010 to December 2016 in our center. Results: The median age at operation was 43 days [interquartile range (IQR): 20-65] and the median weight was 3.6 kg (IQR: 3.4-4.0). Four in-hospital deaths (9.8%), of which one was related to coronary insufficiency. There were no late deaths, with a median follow-up time of 7.2 years. Survival for all patients with single sinus CA was 90.2% at 1 year and remained constant at 5 years and 10 years after ASO. The presence of a coexisting aortic arch anomaly was the only risk factor for overall mortality identified in this study (hazard ratio: 8.66, P  =  .031, 95% confidence interval: 1.21-61.92). There were three cardiac reoperations. Freedom from reintervention after ASO for patients with single sinus CA at 1 year, 5 years, and 10 years were 97.3%, 91.9%, and 91.9%, respectively. Interestingly, among all patients undergoing ASO during this time period (n  =  304), single-sinus CA anatomy was not a risk factor for overall death ( P  =  .758). Conclusions: In a high-volume cardiac program in a lower middle-income country like Vietnam, ASO can be safely performed with single sinus CA anatomy, irrespective of the presenting coronary anatomy.