D-Transposition of the Great Arteries with Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction (D-TGA/VSD/LVOTO): A Survey of Perceptions, Preferences, and Experience

Abstract

Several procedures have been introduced to manage this complex congenital heart malformation. It is not clear that any one approach is best for all patients. Decision-making for a given patient may be influenced by multiple patient factors. There is little doubt that surgeon and institutional experience and preference also play a role. We have focused our survey on three procedures, i.e., the Rastelli, Nikaidoh (aortic root translocation), and réparation à l'étageventriculaire (REV) procedures. The questionnaire was directed to all Congenital Heart Surgeon Society member surgeons. A total of 61 clinical practitioners responded to our survey. Of them, 45 (73.8 %) were staff congenital heart surgeons, 11 (18 %) were staff pediatric cardiologists, 1 (1.6 %) was a staff adult congenital cardiologist, 1 (1.6 %) was a fellow pediatric cardiologist, 2 (3.3 %) were fellow or resident congenital heart surgeons, and 1 (1.6 %) was a nurse practitioner. Most respondents believe that the Rastelli procedure should be considered the first option (n = 28, 45.9 %), while 24 (39.3 %) respondents believe that the Nikaidoh procedure should be considered the first option. Asked "To which surgeon do you prefer to refer your patient" (one who will perform Rastelli, Nikaidoh, or REV), all staff cardiologists (n = 12, 100 %) responded "doesn't matter." This survey revealed a wide diversity among clinical practitioners in terms of management of patients with TGA/VSD/LVOTO and preferred surgical approaches. A multi-institutional study of surgical management of TGA/VSD/LVOTO may help to define principles for optimal matching of procedures to patients.

Rastelli Operation for D-Transposition of the Great Arteries, Ventricular Septal Defect, and Pulmonary Stenosis

“…In a survey of Congenital Heart Surgeon Society members regarding preferred surgical approaches to patients with TGA, VSD, and LVOTO, 28 (45.9%) of the 61 respondents preferred the RO, whereas 24 (39.3%) felt the Nikaidoh should be considered the first option. 8 The survey confirmed the diversity in management of this defect.…”

A Case Report of Hepatocellular Carcinoma Derived from Rastelli Procedure-Related Congestive Liver Disease

“…However, almost half of patients need to undergo reoperation for RVOTO. [13] Mechanisms leading to RVOTO include conduit stenosis and patient's somatic growth [14] [15]. Thus, most patients need to have the reoperation to prevent heart failure [16].…”

Incremental History of the Congenital Heart Surgeons’ Society (2014-2018)

“…Evaluating the impact of any one scientific contribution to the literature is difficult. Certainly, publications that ushered in new operations such as the transposition cohort 2 -11 or resulted in significant therapeutic changes such as the pulmonary atresia intact ventricular septum cohort 12 -15 can be heralded and appreciated. The other cohorts have achieved similar qualitative assessment by our colleagues.…”

“…As a measure of scientific importance and gravitas, all published 53 CHSS manuscripts, appearing on the CHSS Data Center web site, 55 were rated by GoogleScholar 56 by the number of citations in subsequent peer-reviewed journal articles (citation score). The average citation score in peer-reviewed journals (Tables 1 –3) 2 -54 was 75.4 ± 76.3 (standard deviation; median, 49; range, 1-333). This assessment compares favorably with the only other assessment of congenital heart contributions made by this method, 57 which documents an average citation score of 15.5 for 12 congenital heart contributions cited for the Southern Thoracic Surgical Association President’s Award for best paper at the annual meeting.…”