Zhi Gang Liu, Sheng Shou Hu; Pediatric cardiovascular surgery, The National Cardiovascular Institute, Fu Wai Hospital Beijing, Beijing, China
Objective: Surgical treatment of patients with transposition of the great arteries, ventricular septal defect(VSD),and pulmonary stenosis (PS) continues to be a challenge. Three techniques have been developed as the surgical management of this diagnosis: Rastelli, REV, and Nikaidoh Procedure. The present study was designed to compare these procedures in terms of hemodynamics of the re-constructed biventricular outflow tract, early-term clinical consequences, and the follow-up outcomes.Methods: Between March 2004 and September 2006, 30 consecutive patients underwent modified Nikaidoh (NKD, n=11), REV (n=7), and Rastelli (RTL, n=12)procedure. The patient profile is shown in table-1. The operative technique of NKD includes that both aortic and pulmonary root were translocated. A single-valved bovine jugular vein patch was used to repair the stenotic pulmonary artery in both NKD and REV procedure. Senning procedure was added in those with atrioventricular discordance (corrected transposition).
Results: NKD is the most time-consuming procedure in terms of mean cardiopulmonary bypass and aortic cross clamp time compare with REV and RTL. The average mechanical ventilation time was significant shorter in RTL group (63.3±89h.) than in NKD (188.7±159h. p=0.016) but no difference compare with REV (76.4±112.5h. p=0.395). Two patients died in REV group and one in Rastelli. The cause of death was right heart failure, severe bleeding, and LVOT obstruction respectively. There was no in-hospital or late death in NKD group. Post-op echocardiography demonstrated a physiological hemodynamics in LVOT and normal heart function in NKD group. The abnormal flow paten in the LVOT was noticed in both REV and RTL group. There was no late death and re-operation in each group during follow-up.
Conclusion: Modified Nikaidoh procedure is a better surgical option for the treatment of patients with TGA, VSD, and PS in terms of physiological cardiac hemodynamics. Its long-term benefits need to be evaluated by a larger number of patients and longer follow-up study.
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