BACKGROUND: The surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis remains a challenge. The Rastelli operation is the preferred surgical procedure, but its long-term results are not optimal. The objective in this retrospective study was to review our experience using aortic translocation and biventricular outflow tract reconstruction as an alternative surgical procedure for the management of these patients. METHODS: Since January 1996, 12 patients have undergone aortic translocation and biventricular outflow tract reconstruction for the management of transposition of the great arteries, ventricular septal defect, and pulmonary stenosis at our institution. All patients had ventriculoarterial discordance; 9 had atrioventricular concordance and 3 atrioventricular discordance. Associated lesions included a straddling atrioventricular valve in 3 patients. An inlet ventricular septal defect was present in 4 patients. The median age at operation was 2 years. Eight patients had previous palliative procedures. The surgical technique used was a modification of the Nikaidoh procedure. The 3 patients with atrioventricular discordance required a Senning procedure. RESULTS: There was one hospital death (8.3%) as a result of a massive cerebrovascular accident. The median intensive care unit and hospital stays were 15 and 18 days, respectively. At a median follow-up of 33 months, all patients are alive. Four late reoperations occurred in 3 patients, including two reoperations for conduit obstruction. CONCLUSIONS: Aortic translocation and biventricular outflow tract reconstruction is a valuable surgical option for the surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis, especially in the presence of "inadequate anatomy" for a Rastelli repair.
BACKGROUND: The surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis remains a challenge. The Rastelli operation is the preferred surgical procedure, but its long-term results are not optimal. The objective in this retrospective study was to review our experience using aortic translocation and biventricular outflow tract reconstruction as an alternative surgical procedure for the management of these patients. METHODS: Since January 1996, 12 patients have undergone aortic translocation and biventricular outflow tract reconstruction for the management of transposition of the great arteries, ventricular septal defect, and pulmonary stenosis at our institution. All patients had ventriculoarterial discordance; 9 had atrioventricular concordance and 3 atrioventricular discordance. Associated lesions included a straddling atrioventricular valve in 3 patients. An inlet ventricular septal defect was present in 4 patients. The median age at operation was 2 years. Eight patients had previous palliative procedures. The surgical technique used was a modification of the Nikaidoh procedure. The 3 patients with atrioventricular discordance required a Senning procedure. RESULTS: There was one hospital death (8.3%) as a result of a massive cerebrovascular accident. The median intensive care unit and hospital stays were 15 and 18 days, respectively. At a median follow-up of 33 months, all patients are alive. Four late reoperations occurred in 3 patients, including two reoperations for conduit obstruction. CONCLUSIONS: Aortic translocation and biventricular outflow tract reconstruction is a valuable surgical option for the surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis, especially in the presence of "inadequate anatomy" for a Rastelli repair.