Results after Repair of D-Transposition of the Great Arteries with VSD and Left Ventricular Outflow Obstruction
Anna Olds, Yuki Nakamura, Stephanie Levasseur, Amee Shah, Lindsay Freud, Anjali Chelliah, Paul Chai, Jan Quaegebeur, Emile Bacha, David Kalfa.
Columbia University Medical Center - NY Presbyterian Hospital, New York, NY, USA.
Objective(s): D-transposition of the great arteries (TGA) or TGA-type double outlet right ventricle (DORV) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) may be treated with the arterial switch operation (ASO), Rastelli, Réparation à l'Etage Ventriculaire (REV), or Nikaidoh procedures. We evaluated mid-term results of these techniques.
Methods: We retrospectively reviewed 42 cases of anatomic repair from 2005-2014 at our institution for TGA (n=29) or TGA-type DORV (n=13) with VSD and LVOTO. We analyzed outcomes (mortality, reoperation, residual/recurrent LVOT peak gradient ≥20mmHg, right ventricular outflow tract (RVOT) peak gradient ≥40mmHg) and performed a risk analysis. Mean follow-up was 3.84±4.05 years.
Results: Seventeen patients (40.5%) had an ASO with (n=5) or without (n=12) LVOTO resection. The Rastelli, REV, and Nikaidoh procedures were used in 14 (33%), 5 (12%), and 6 (14%) patients, respectively. No hospital or late mortality occurred and no moderate/severe aortic insufficiency was present at last follow-up. LVOT gradient ≥20mmHg developed in 3 patients (7%), while 9 patients (21.4%) had RVOT obstruction. Reoperations included RVOT/pulmonary artery reoperation (n=10; 23.8%), and LVOT reoperation (n=1; 2.5%). Freedom from reoperation was 84±6% and 75±9% at 1 and 3 years, respectively. The Nikaidoh procedure compared favorably to all other techniques in terms of reoperation (n=0/6; 0% vs. n=13/36; 36%; p=0.08).
Conclusions: Mid-term outcomes after anatomic repair for TGA or TGA-type DORV with LVOTO and VSD are excellent, but vary according to surgical technique. The Nikaidoh procedure seems to compare favorably to the other techniques.
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