Double Root Translocation__ A true-meaning anatomic repair for anomalies of ventriculoarterial connection with pulmonary outflow tract obstruction
Sheng Shou Hu, Zhigang Liu, Shou Jun Li; The National Cardiovascular Institute and Fu Wai Hospital Beijing, Beijing, China
Comment on this Abstract
Objective: Surgical management for patients with ventriculoarterial discordance, ventricular septal defect (VSD), and pulmonary outflow tract obstruction (PS) remains a challenge. As the conventional treatment for this lesion, Rastelli procedure has been revealed with poor long-term results, an alternative surgical technique is required. Aiming to preserve the competence and growth potential of the native pulmonary valve and acquire a better long-term results, we proposed the “double root translocation” technique for biventricular outflow tract reconstruction. Herein we present our successful experiences in 25 consecutive patients.
Methods: Between November 2004 and August 2007, 25 consecutive patients underwent “double root translocation” procedure. The median age at operation was 4.3 (range from 0.7 to 18) years. Transposition of great arteries (TGA) with VSD and PS were diagnosed in nineteen patients (four had atrioventricular discordance) and double outlet right ventricle (Taussig-Bing anomalies) with PS in six cases. The operative technique includes that both aortic and pulmonary root were mobilized, excised and translocated. A monovalved bovine jugular vein patch was used to repair the stenotic pulmonary artery. Coronary arteries re-attachment was needed in five patients. Major concomitant procedure included Senning operation in four cases and Glenn in one.
Results: The mean cardiopulmonary bypass and aortic cross clamp time were 322±56min. and 224±41min. respectively. The mean mechanical ventilation time was 141±157 hours. Three patients required ECMO support and recovered. All patients survived and discharged. There was no late death in the present series. Post-op echocardiography demonstrated a physiological hemodynamics in LVOT and normal heart function in 24 cases. Four patients had a competent pulmonary valve and twenty had mild to medium pulmonary insufficiency. Only one patient presented mild aortic and mitral valve regurgitation. No re-intervention needed during follow-up.
Conclusion: The “double root translocation” technique is a feasible and effective procedure for the patients with anomalies of ventriculoarterial connection, VSD, and PS. Its long-term benefits need to be demonstrated by a larger number of patients and longer follow-up study.
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