Vijayakumar Raju1, Patrick O Myers2, Luis G Quinonez1, Sitaram M Emani1, John E Mayer1, Frank A Pigula1, Pedro J del Nido1, Christopher W Baird3. 1. Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass. 2. Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Division of Cardiovascular Surgery, Geneva University Hospitals and School of Medicine, Geneva, Switzerland. 3. Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass. Electronic address: christopher.baird@cardio.chboston.org.
Abstract
OBJECTIVE: Aortic root translocation is a promising surgical option for repair of transposition of the great arteries, ventricular septal defect, and pulmonary stenosis. There are little data on the outcomes of this procedure, with no long-term follow-up available. We reviewed our experience with aortic root translocation and the impact of the type of right ventricular outflow tract reconstruction. METHODS: The demographic, procedural, and outcome data were obtained for 32 patients who underwent aortic root translocation from 1997 to 2013 at Boston Children's Hospital. Patients were grouped on the basis of right ventricular outflow tract reconstruction with a valved conduit or a nonvalved anastomosis of the pulmonary artery bifurcation to the right ventricular outflow tract with anterior patch augmentation (transannular patch). RESULTS: The median age was 7.5 months (16 days to 42 years). Twenty-six patients had valved conduits, and 6 patients had transannular patches. There were no significant differences between groups in baseline and operative characteristics. There was 1 early death (transannular patch group). There were no late deaths during a median follow-up of 20.8 months (1 month to 16.5 years). No patients developed late left ventricular outflow tract obstruction. Transcatheter reintervention was required in 14 patients, 9 with valved conduits (34.6%) and 1 with transannular patch (20%, P > .99). Six patients (19.4%) required reoperation, all with a valved conduit (P = .34). CONCLUSIONS: Aortic root translocation can be done with low early and late mortality. There was preserved aortic valve function and no left ventricular outflow tract obstruction at late follow-up. The use of a transannular patch had early outcomes comparable to valved conduits, with a trend for fewer late reoperations.
OBJECTIVE: Aortic root translocation is a promising surgical option for repair of transposition of the great arteries, ventricular septal defect, and pulmonary stenosis. There are little data on the outcomes of this procedure, with no long-term follow-up available. We reviewed our experience with aortic root translocation and the impact of the type of right ventricular outflow tract reconstruction. METHODS: The demographic, procedural, and outcome data were obtained for 32 patients who underwent aortic root translocation from 1997 to 2013 at Boston Children's Hospital. Patients were grouped on the basis of right ventricular outflow tract reconstruction with a valved conduit or a nonvalved anastomosis of the pulmonary artery bifurcation to the right ventricular outflow tract with anterior patch augmentation (transannular patch). RESULTS: The median age was 7.5 months (16 days to 42 years). Twenty-six patients had valved conduits, and 6 patients had transannular patches. There were no significant differences between groups in baseline and operative characteristics. There was 1 early death (transannular patch group). There were no late deaths during a median follow-up of 20.8 months (1 month to 16.5 years). No patients developed late left ventricular outflow tract obstruction. Transcatheter reintervention was required in 14 patients, 9 with valved conduits (34.6%) and 1 with transannular patch (20%, P > .99). Six patients (19.4%) required reoperation, all with a valved conduit (P = .34). CONCLUSIONS: Aortic root translocation can be done with low early and late mortality. There was preserved aortic valve function and no left ventricular outflow tract obstruction at late follow-up. The use of a transannular patch had early outcomes comparable to valved conduits, with a trend for fewer late reoperations.
Authors: Han Pil Lee; Ji Hyun Bang; Jae-Suk Baek; Hyun Woo Goo; Jeong-Jun Park; Young Hwee Kim Journal: Korean J Thorac Cardiovasc Surg Date: 2016-06-05