Bex-Nikaidoh operation and the impact of double root translocation on outcomes

Abstract

OBJECTIVES The Bex-Nikaidoh operation can effectively relieve left ventricular outflow tract obstruction. However, if a conduit is used for right ventricular outflow tract reconstruction, late reoperation can be anticipated. We examined the impact of double root translocation on outcomes. METHODS This is a retrospective single-center study of patients who underwent aortic root translocation between 2006 and 2019. RESULTS Aortic root translocation was performed in 23 patients at a median age of 1.6 years (IQR 0.9–2.5). Concomitant repairs were done in 52.2% of patients (12/23) including Senning atrial switch in 34.8% (8/23). The right ventricular outflow tract was reconstructed with valved conduits in 39.1% (9/23), direct anastomosis in 4.35% (1/23) and pulmonary autograft in 56.5% of patients (13/23). Aortic cross-clamp time was significantly longer in patients with double root translocation (308 min (IQR 270–259) vs 209 min (IQR 179–281), P = 0.02) and two patients in this group required temporary mechanical circulatory support. There was no early mortality. Median follow-up time was 7.5 years (IQR 3.3–10.5). Estimated 10-year survival was 90% (95% CI 47.3%–98.5%). There was no recurrent left ventricular outflow tract obstruction. Freedom from any reoperation was 64.2% (95% CI 40.8%–80.3%) at 3 years and 44.5% (95% CI 21.2%–65.5%) at 6 years. Main indication for late reoperation was conduit degeneration. Freedom from right ventricular outflow tract reoperation was significantly higher and number of reoperations per patient was lower when double root translocation had been performed (P = 0.03). CONCLUSIONS Bex-Nikaidoh operation effectively relieved left ventricular outflow tract obstruction. Double root translocation further increased procedural complexity, but was associated with better mid-term freedom from right ventricular outflow tract reoperation. It should be considered in suitable patients.