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| Fate of Reconstructed Biventricular Outflow Tracts after Repair for Transposition of the Great Arteries with Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction: Midterm Results and Future Implications | |
Sheng-shou Hu, Yan Li, Shoujun Li, Zhigang Liu, Zhe Zheng, Yongqing Li; Cardiovascular Surgery, National Heart Center and Fuwai Hospital, Beijing, China
Methods: Between 2004 and 2008, 103 consecutive patients with TGA/VSD/LVOTO underwent biventricular repair: Rastelli (n=48), REV (n=15), and double (aortic and pulmonary) root translocation (DRT, n=40). The median age at operation was 5.2 years (range 0.7 to 19). The operative technique of DRT includes that both native aortic and pulmonary roots were excised and translocated. In REV and DRT group, right ventricular outflow tract (RVOT) reconstruction was achieved with a single-valved bovine jugular vein patch. All these patients were reviewed for in-hospital and follow-up echocardiographic assessment of reconstructed biventricular outflow tracts. Results: There were 7 in-hospital deaths (Rastelli: 4, REV: 2, DRT: 1). Within a median follow-up of 24 months (range 3 to 54 months) there were no late deaths. Concerning neo-LVOT, the follow-up gradient was 4 to 52 mm Hg (median 24) in Rastelli group and 2 to 44 mm Hg (median 18) in REV group. In DRT group the follow-up LVOT gradient was 2 to 20 mm Hg (median 8), unchanged from early postoperative condition. Rastelli procedure, VSD/aortic size discrepancy and duration of follow-up time were main precursors of recurrent LVOTO (gradient>25mmHg). Aortic regurgitation of 2 or greater developed in 10.9% in Rastelli group, 7.7% in REV group and none in DRT group. Concerning the neo-RVOT, the follow-up gradient was 9 to 35 mmHg (median 16) in Rastelli group, 4 to 25 mm Hg (median 10) in REV group, and 2 to 24 mm Hg (median 10) in DRT group. Moderate or greater pulmonary regurgitation developed in 15.9% in Rastelli group versus 7.7% in REV group and 5.1% in DRT group. Rastelli procedure and duration of follow-up time were the principal determinant of moderate or greater pulmonary regurgitation. Conclusion: Midterm results of DRT procedure, a more anatomic repair compared with Rastelli or REV procedure, indicate effective relief of LVOTO and better hemodynamic performance of both reconstructed outflow tracts. Because €śtime€ť is a principal predictor of the fate of outflow tracts, strict follow-up after operation is mandatory. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
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All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.