The Clinical Outcomes of Damus-Kaye-Stansel Procedure According to Surgical Technique

Abstract

BackgroundThe Damus-Kaye-Stansel (DKS) procedure is a method for mitigating the risk of systemic ventricular outflow tract obstruction (SVOTO). However, there have been few reports on which surgical technique shows a better outcome. The objective of this study was to compare the outcome of the DKS procedure according to the surgical technique used.MethodsWe retrospectively reviewed 12 consecutive patients who underwent the DKS procedure from March 2004 to April 2013. When the relationship of the great arteries was anterior-posterior, the double-barrel technique (group A) was performed. If the relationship was side-by-side, the ascending aortic flap technique (group B) was performed.ResultsThere was no early mortality and 1 late mortality in group B. There was no statistically significant difference in the median peak pressure gradient of preoperative subaortic stenosis in both groups: 14 mmHg (range, 4 to 53 mmHg) in group A and 15 mmHg (range, 0 to 30 mmHg) in group B (p=0.526). Further, a significant postoperative pressure gradient was not observed in either group A or group B. More than moderate postoperative neoaortic regurgitation was observed in 1 patient of group B; this patient underwent neoaortic valve replacement 66 months after the DKS procedure. No one had a recurrent SVOTO during follow-up.ConclusionThe DKS procedure is an effective way to minimize the risk of SVOTO, and there is little difference in the outcomes of the DKS procedure according to the surgical technique used.

Percutaneous coronary stent implantation in children and young infants following surgical repair of congenital heart disease

“…The most common underlying cardiac morphologies were congenital aortic valve stenosis (AS, n=5), transposition of great arteries (TGA) (n=2), single ventricle lesions (n=2), Shone’s complex (n=1), and truncus arteriosus type Ⅲ (n=1). The most common procedures associated with CAO were the Bentall procedure ( 11 ) (n=4), ASO (n=2), Damus–Kaye–Stansel (DKS) procedure ( 12 ) with Blalock-Taussig (BT) shunt (n=2), Konno procedure (n=2), and Ross-Konno procedure ( 13 ) (n=1). All the procedures included coronary arteries reimplantation except DKS and Konno procedures.…”

Tricuspid atresia: Where are we now?

“…Another subgroup to be aware of is those suffering from both TA and TGA. These patients commonly develop subaortic stenosis and outflow tract obstruction, which may require VSD enlargement and resection of the subaortic conus 37 . However, as this can result in complications such as heart block, an alternative method known as the Damus‐Kaye‐Stansel (DKS) procedure is often used 37 .…”

“…These patients commonly develop subaortic stenosis and outflow tract obstruction, which may require VSD enlargement and resection of the subaortic conus 37 . However, as this can result in complications such as heart block, an alternative method known as the Damus‐Kaye‐Stansel (DKS) procedure is often used 37 . This involves an end‐to‐side anastomosis between the main pulmonary artery and ascending aorta 38 .…”

“…37 However, as this can result in complications such as heart block, an alternative method known as the Damus-Kaye-Stansel (DKS) procedure is often used. 37 This involves an end-to-side anastomosis between the main pulmonary artery and ascending aorta. 38 More recently, a double-barrel variant of the DKS procedure has emerged, in which the main pulmonary artery and initial aortic segment lead into a single ascending aorta.…”

Surgical treatment for the single ventricle with subaortic obstruction. Clinical case of the Damus-Kaye-Stansel procedure

“…In newborns, pulmonary blood flow is provided by a systemic-pulmonary shunt or conduit from the right ventricle, and in older children, the procedure is accompanied by the imposition of a bidirectional cava-pulmonary anastomosis. The potential disadvantages of DKS include the distortion of the semilunar valves, followed by regurgitation and an increased volume load of the single ventricle, which is more typical for patients undergoing an endto-side anastomosis, as well as the risk of compression of the left pulmonary arteries or the left main bronchus, especially with non-parallel orientation of the great vessels [7,8].…”