Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERY49. Fate of Reconstructed Biventricular Outflow Tracts After Repairfor Transposition of the Great Arteries with Ventricular SeptalDefect and Left Ventricular Outflow Tract Obstruction: MidtermResults and Future ImplicationsSheng-Shou Hu, * Yan Li, Shoujun Li, Zhigang Liu, Zhe Zheng, Yongqing LiCardiovascular Surgery, National Heart Center and Fuwai Hospital, Beijing, ChinaInvited Discussant: Pdefro J. del NidoOBJECTIVE: Three techniques have been used as the surgical repair for patientswith transposition of the great arteries with ventricular septal defect and left ventricularoutflow tract obstruction (TGA/VSD/LVOTO): Rastelli, Lecompte (REV),and root translocation procedures. This study was designed to compare the midtermresults of these 3 procedures with respect to echocardiographic analysis of thereconstructed biventricular outflow tracts.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 operationwas 5.2 years (range 0.7 to 19). The operative technique of DRT includes thatboth native aortic and pulmonary roots were excised and translocated. In REV andDRT group, right ventricular outflow tract (RVOT) reconstruction was achievedwith a single-valved bovine jugular vein patch. All these patients were reviewed forin-hospital and follow-up echocardiographic assessment of reconstructed biventricularoutflow tracts.TUESDAYAfternoonRESULTS: There were 7 in-hospital deaths (Rastelli: 4, REV: 2, DRT: 1). Within amedian 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) inRastelli group and 2 to 44 mm Hg (median 18) in REV group. In DRT group thefollow-up LVOT gradient was 2 to 20 mm Hg (median 8), unchanged from earlypostoperative condition. Rastelli procedure, VSD/aortic size discrepancy and durationof follow-up time were main precursors of recurrent LVOTO (gradient > 25 mmHg).Aortic regurgitation of 2 or greater developed in 10.9% in Rastelli group, 7.7% inREV group and none in DRT group. Concerning the neo-RVOT, the follow-up gradientwas 9 to 35 mmHg (median 16) in Rastelli group, 4 to 25 mm Hg (median 10)in REV group, and 2 to 24 mmHg (median 10) in DRT group. Moderate or greaterpulmonary regurgitation developed in 15.9% in Rastelli group versus 7.7% in REVgroup and 5.1% in DRT group. Rastelli procedure and duration of follow-up timewere the principal determinant of moderate or greater pulmonary regurgitation.CONCLUSION: Midterm results of DRT procedure, a more anatomic repaircompared with Rastelli or REV procedure, indicate effective relief of LVOTO andbetter hemodynamic performance of both reconstructed outflow tracts. Because“time” is a principal predictor of the fate of outflow tracts, strict follow-up afteroperation is mandatory.3:00 p.m. INTERMISSION – VISIT EXHIBITSExhibit Hall* AATS Member187