Outcomes After Anatomic Repair for D-Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction

Abstract

Background-D-transposition of the great arteries (TGA) with left ventricular outflow tract obstruction (LVOTO) may be treated with arterial switch operation (ASO) with or without LVOT intervention, as well as non-ASO anatomic repairs, such as aortic translocation or Rastelli procedure. We evaluated midterm results of repair for TGA/LVOTO at our institution. Methods and Results-Eighty-eight patients with TGA/LVOTO who underwent anatomic repair were retrospectively reviewed. LVOTO was defined as pulmonary valve (PV) z-score ՅϪ2.0 or LVOT gradient Ն20 mm Hg in the presence of anatomic subvalvar stenosis. Risk factors for LVOT reintervention were determined by logistic regression. There was no hospital mortality and 1 late mortality. Patients undergoing Rastelli procedure were more likely to require surgical reintervention for LVOTO compared to the other groups (Pϭ0.015). Patients undergoing ASO alone had a higher rate of late LVOT reintervention compared to those who had concomitant ASO/LVOT intervention (PϭNS). In those undergoing Rastelli, a larger PV z-score was a predictor of LVOT reintervention (Pϭ0.012). PV z-scores significantly decreased before repair in patients undergoing delayed repair (Pϭ0.005); however, they increased significantly after neonatal ASO (PϽ0.001). Conclusions-Patients

Primary repair of symptomatic neonates with tetralogy of Fallot with or without pulmonary atresia

“…Follow-up echocardiography suggested a trend towards 'catch-up' growth of the annulus. By contrast, in a disease entity distinct from TOF, Emani et al34) showed progressive decrease in the pulmonary valve annular size in cases of delayed anatomic repair beyond the neonatal period. They suggested that antegrade blood flow may provide the stimulus for growth of ventricular outflow tract structures, while palliative maneuvers such as aortopulmonary shunts may lead to a reduction in blood flow through the outlet area.…”

Midterm follow-up of arterial switch operation for transposition of the great arteries with intact ventricular septum and left-ventricular outflow tract obstruction☆

“…One of the concerns with performing ASO for patients with TGA/IVS/LVOTO is the development of neo-AR over time [3,7]. LVOTO has been shown to be a risk factor for development of significant regurgitation [11].…”

“…There is a paucity of publications reporting mid-and longterm outcomes after ASO for TGA/IVS/LVOTO [2,3,7]. The purpose of this study was to review our experience with this subset of patients with particular reference to mid-term outcomes.…”

Restoration of Transposed Great Arteries With or Without Subpulmonary Obstruction to Nature

“…We have demonstrated that the common wall between the great arteries could grow and become thinner on follow-up (Chiu et al, 2009). Spiral reconstruction in TGA is seldom performed, because the functional implications of spiral relationship of the great arteries remain unknown; thus, the Lecompte maneuver was used either in conventional ASO or Nikaidoh and Lecompte (REV) operation (Emani et al, 2009;Morell & Wearden, 2006;Lecompte et al, 1982). Review of surgical treatment for TGA reveals that once the functional implications of two normal ventricles were well known, nobody selected the right ventricle as the systemic pumping chamber.…”

“…In the past, few practiced this procedure because of its demanding techniques and potentially worse outcome. However, aortic translocation has recently gained popularity as an alternative to the Rastelli operation and Reparation l'etage ventriculaire (REV) as the treatment for TGA with a left ventricular outflow obstruction (Rastelli, 1969;Yeh et al, 2007;Emani et al, 2009). ASO has become the procedure of choice for TGA (Prêtre et al, 2001;Losay et al, 2002).…”