Prognosis of the complete transposition of great arteries with left ventricular outflow tract obstruction after intraventricular repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XING Yunchao , LI Shoujun , YAN Jun , WANG Xu , YAN Fuxia , YI Tong , JIANG Xianchao , MA Zhiling ,  WANG Qiang

Pediatric Cardiac Surgical Centre, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

WANG Qiang, Email: wq.cory@163.com

Keywords：

Complete transposition of great arteries; left ventricular outflow tract obstruction; intraventricular repair; prognostic analysis

DOI：

10.7507/1007-4848.201808048

Video：

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Objective To compare the clinical characteristics and prognosis of patients who received two different intraventricular repair. Methods We retrospectively analyzed the clinical data of 24 complete transposition of the great arteries (TGA)/left ventricular outflow tract obstruction (LVOTO) patients who all received intraventricular repair. The patients were allocated into two groups including a REV group and a Rastelli group. There were 13 patients with 9 males and 4 females at median age of 25.2 (6, 72) months in the REV group. There were 11 patients with 10 males and 1 female at median age of 47.9 (14, 144) months in the Rastelli group. Results The age at operation (P=0.041), pulmonary valve Z value (P=0.002), and LVOT gradient (P=0.004), rate of multiphase operation between the REV group and the Rastelli group was statistically different. The mean follow-up time was 17.3 months. And during the follow-up, 1 patient had early mortality, 2 patients had early reintervention, 7 patients had postoperative RVOTO, and received Rastelli and larger VSD inner diameter were associated with postoperative RVOTO. Conclusion As the traditional surgery for TGA/LVOTO patients, the intraventricular repair has a low early mortality and low early reintervention. Modified REV is associated with postoperative peripheral pulmonary vein isolation (PVIS). Patients who received Rastelli operation and with larger VSD inner diameter are more likely to have postoperative RVOTO, but the reintervention for PVI and RVOTO during follow up is very low.

Citation： XING Yunchao, LI Shoujun, YAN Jun, WANG Xu, YAN Fuxia, YI Tong, JIANG Xianchao, MA Zhiling, WANG Qiang. Prognosis of the complete transposition of great arteries with left ventricular outflow tract obstruction after intraventricular repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(6): 534-538. doi: 10.7507/1007-4848.201808048 Copy

1.	Emani SM, Beroukhim R, Zurakowski D, et al. Outcomes after anatomic repair for d-transposition of the great arteries with left ventricular outflow tract obstruction. Circulation, 2009, 120(11 Suppl): S53-S58.
2.	高华炜, 李守军, 闫军, 等. 完全型大动脉转位行大动脉调转术十年 (2001~2012 年) 的变化趋势——单中心报告. 中国胸心血管外科临床杂志, 2015, 22(7): 638-641.
3.	贺东, 吴清玉. Rastelli 手术治疗复杂先天性心脏病. 中华胸心血管外科杂志, 2003, 10(3): 51-52.
4.	胡盛寿, 李巅远, 沈向东, 等. 保留肺动脉瓣的改良 REV 手术治疗复杂型大动脉转位——附 3 例报道及文献综述. 中国胸心血管外科临床杂志, 2006, 13(4): 215-217.
5.	胡盛寿, 李守军, 王欣, 等. 改良 Nikaidoh 手术治疗伴左室流出道狭窄的大动脉转位. 中华胸心血管外科杂志, 2006, 13(6): 381-382.
6.	Sharma R, Choudhary SK, Bhan A, et al. Late outcome after arterial switch operation for complete transposition of great arteries with left ventricular outflow tract obstruction. Ann Thorac Surg, 2002, 74(6): 1986-1991.
7.	Vouhé PR, Tamisier D, Leca F, et al. Transposition of the great arteries, ventricular septal defect, and pulmonary outflow tract obstruction. Rastelli or Lecompte procedure? J Thorac Cardiovasc Surg, 1992, 103(3): 428-436.
8.	Di Carlo D. REV (Lecompte) procedure: how much better than the Rastelli operation. Eur J Cardiothorac Surg, 2004, 26(6): 1226-1227.
9.	Kalfa D, Vergnat M, Baruteau AE, et al. Damus anastomosis associated with REV/Rastelli procedure allows to extend indications for anatomical repair in complex transposition of great arteries. Interact Cardiovasc Thorac Surg, 2014, 18(6): 844-846.
10.	Hörer J, Schreiber C, Dworak E, et al. Long-term results after the Rastelli repair for transposition of the great arteries. Ann Thorac Surg, 2007, 83(6): 2169-2175.
11.	Kreutzer C, De Vive J, Oppido G, et al. Twenty-five-year experience with rastelli repair for transposition of the great arteries. J Thorac Cardiovasc Surg, 2000, 120(2): 211-223.
12.	Cleveland DC, Kirklin JK, Pavnica JW, et al. Late left ventricular outflow tract obstruction following the Rastelli operation: expectations out to 20 years. World J Pediatr Congenit Heart Surg, 2016, 7(5): 605-610.
13.	Brown JW, Ruzmetov M, Huynh D, et al. Rastelli operation for transposition of the great arteries with ventricular septal defect and pulmonary stenosis. Ann Thorac Surg, 2011, 91(1): 188-193.
14.	Wu KL, Wang JK, Lin MT, et al. Left ventricular outflow tract obstruction in complete transposition of the great arteries——echocardiography criteria for surgical strategies. Circ J, 2010, 74(6): 1214-1218.
15.	Hazekamp M, Portela F, Bartelings M. The optimal procedure for the great arteries and left ventricular outflow tract obstruction. An anatomical study. Eur J Cardiothorac Surg, 2007, 31(5): 879-887.
16.	贺东, 吴清玉, 许建屏, 等. Rastelli 手术治疗完全大动脉转位合并室间隔缺损及肺动脉瓣下狭窄. 中日友好医院学报, 2002, 16(4): 215-217.

1. Emani SM, Beroukhim R, Zurakowski D, et al. Outcomes after anatomic repair for d-transposition of the great arteries with left ventricular outflow tract obstruction. Circulation, 2009, 120(11 Suppl): S53-S58.
2. 高华炜, 李守军, 闫军, 等. 完全型大动脉转位行大动脉调转术十年 (2001~2012 年) 的变化趋势——单中心报告. 中国胸心血管外科临床杂志, 2015, 22(7): 638-641.
3. 贺东, 吴清玉. Rastelli 手术治疗复杂先天性心脏病. 中华胸心血管外科杂志, 2003, 10(3): 51-52.
4. 胡盛寿, 李巅远, 沈向东, 等. 保留肺动脉瓣的改良 REV 手术治疗复杂型大动脉转位——附 3 例报道及文献综述. 中国胸心血管外科临床杂志, 2006, 13(4): 215-217.
5. 胡盛寿, 李守军, 王欣, 等. 改良 Nikaidoh 手术治疗伴左室流出道狭窄的大动脉转位. 中华胸心血管外科杂志, 2006, 13(6): 381-382.
6. Sharma R, Choudhary SK, Bhan A, et al. Late outcome after arterial switch operation for complete transposition of great arteries with left ventricular outflow tract obstruction. Ann Thorac Surg, 2002, 74(6): 1986-1991.
7. Vouhé PR, Tamisier D, Leca F, et al. Transposition of the great arteries, ventricular septal defect, and pulmonary outflow tract obstruction. Rastelli or Lecompte procedure? J Thorac Cardiovasc Surg, 1992, 103(3): 428-436.
8. Di Carlo D. REV (Lecompte) procedure: how much better than the Rastelli operation. Eur J Cardiothorac Surg, 2004, 26(6): 1226-1227.
9. Kalfa D, Vergnat M, Baruteau AE, et al. Damus anastomosis associated with REV/Rastelli procedure allows to extend indications for anatomical repair in complex transposition of great arteries. Interact Cardiovasc Thorac Surg, 2014, 18(6): 844-846.
10. Hörer J, Schreiber C, Dworak E, et al. Long-term results after the Rastelli repair for transposition of the great arteries. Ann Thorac Surg, 2007, 83(6): 2169-2175.
11. Kreutzer C, De Vive J, Oppido G, et al. Twenty-five-year experience with rastelli repair for transposition of the great arteries. J Thorac Cardiovasc Surg, 2000, 120(2): 211-223.
12. Cleveland DC, Kirklin JK, Pavnica JW, et al. Late left ventricular outflow tract obstruction following the Rastelli operation: expectations out to 20 years. World J Pediatr Congenit Heart Surg, 2016, 7(5): 605-610.
13. Brown JW, Ruzmetov M, Huynh D, et al. Rastelli operation for transposition of the great arteries with ventricular septal defect and pulmonary stenosis. Ann Thorac Surg, 2011, 91(1): 188-193.
14. Wu KL, Wang JK, Lin MT, et al. Left ventricular outflow tract obstruction in complete transposition of the great arteries——echocardiography criteria for surgical strategies. Circ J, 2010, 74(6): 1214-1218.
15. Hazekamp M, Portela F, Bartelings M. The optimal procedure for the great arteries and left ventricular outflow tract obstruction. An anatomical study. Eur J Cardiothorac Surg, 2007, 31(5): 879-887.
16. 贺东, 吴清玉, 许建屏, 等. Rastelli 手术治疗完全大动脉转位合并室间隔缺损及肺动脉瓣下狭窄. 中日友好医院学报, 2002, 16(4): 215-217.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognosis of the complete transposition of great arteries with left ventricular outflow tract obstruction after intraventricular repair

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