Pulmonary root translocation in malposition of great arteries repair allows right ventricular outflow tract growth

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• 作者：José ; Pedro da Silva ; MD^a ; ^{dasilvajp@uol.com.br} ; Luciana da Fonseca da Silva ; MD^a ; Lilian Maria Lopes ; MD^a ; Luiz Felipe Moreira ; MD^b ; Luiz Fernando Caneo ; MD^b ; Sonia Meiken Franchi ; MD^a ; Alessandro Cavalcanti Lianza ; MD^a ; José ; Francisco Baumgratz ; MD^a ; Jefferson Duarte Flavio Magalhaes ; MD^c
• 关键词：20 ; 21 ; 35
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2012
• 出版时间：June, 2012
• 年：2012
• 卷：143
• 期：6
• 页码：1292-1298
• 全文大小：546 K

文摘

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Objective

Optimal surgical treatment of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and pulmonary stenosis (PS) remains a matter of debate. This study evaluated the clinical outcome and right ventricle outflow tract performance in the long-term follow-up of patients subjected to pulmonary root translocation (PRT) as part of their surgical repair.

Methods

From April 1994 to December 2010, we operated on 44 consecutive patients (median age, 11 months). All had malposition of the great arteries as follows: TGA with VSD and PS (n?=?33); double-outlet right ventricle with subpulmonary VSD (n?=?7); double-outlet right ventricle with atrioventricular septal defect (n?=?1); and congenitally corrected TGA with VSD and PS (n?=?3). The surgical technique consisted of PRT from the left ventricle to the right ventricle after construction of an intraventricular tunnel that diverted blood flow from the left ventricle to the aorta.

Results

The mean follow-up time was 72 ¡À 52.1 months. There were 3 (6.8 % ) early deaths and 1 (2.3 % ) late death. Kaplan-Meier survival was 92.8 % and reintervention-free survival was 82.9 % at 12 years. Repeat echocardiographic data showed nonlinear growth of the pulmonary root and good performance of the valve at 10 years. Only 4 patients required reinterventions owing to right ventricular outflow tract problems.

Conclusions

PRT is a good surgical alternative for treatment of patients with TGA complexes, VSD, and PS, with acceptable operative risk, high long-term survivals, and few reinterventions. Most patients had adequate pulmonary root growth and performance.