Objective Complex congenital heart defects are sometimes treated by Fontan palliation for various reasons. However, the middle- and long-term prognosis of single-ventricle repair is worse than that of two-ventricle repair. In this study we reported the results of biventricular conversion in these challenging patients initially palliated towards single-ventricle repair. Methods Eight patients underwent biventricular repair conversion from prior bidirectional Glenn shunt palliation in our hospital between October 2013 and March 2016. The median age in bidirectional Glenn shunt was 2.6 years (range, 1.0 to 5.9 years) and in biventricular repair conversion was 6.6 years (range, 4.5 to 11.1 years). Three patients suffered complete transposition of great arteries combined with ventricular septal defect and left ventricular outflow tract obstruction, three double outlet right ventricle and non-committed ventricular septal defect combined with pulmonary stenosis or atresia, one double outlet right ventricle combined with complete ativentricular septal defect and pulmonary stenosis and one Tetralogy of Fallot. Results Bidirectional Glenn shunt was taken down and superior vena cava was reconnected to the right atrium in all patients. Mean cardiopulmonary bypass and aortic cross-clamp time was 275.6±107.1 min and 165.9±63.6 min, respectively. Mean length of hospital stay and ICU stay were 33.6±23.0 d and 20.3±21.0 d, respectively. At a mean follow-up of 1.4±0.7 years, there was no mortality and reoperation. No patients presented with sinoatrial node dysfunction and superior vena cava anastomotic stenosis. According to the New York Heart Association (NYHA) Functional Classification, all patients were classified asⅠ-Ⅱ. Conclusion Biventricular repair conversion can be safely performed with favorable mortality and morbidity in specific patients palliated towards single-ventricle repair. Further follow-up is needed to investigate the long-term outcomes.
Objective To investigate the risk factors of neoaortic regurgitation (NAR) after the arterial switch operation (ASO) for transposition of the great arteries (TGA). Methods This retrospective study enrolled 229 patients with TGA who underwent ASO from January 2008-2013 in Fu Wai Hospital, including 173 males and 56 females with an average age of 7.8±15.9 months (range, 3 days to 93.9 months; median, 47 days) and an average weight of 6.3±4.2 kg (range, 4 to18 kg; median, 2.4 kg). Results The mean follow-up was 62.5±31.1 months and the shortest was 36 months. Twenty eight patients (12.2%) suffered at least moderate NAR. In Kaplan-Meier survival analysis, probability of freedom from at least moderate NAR was 100.0%, 100.0%, 99.6%, 95.3% at year 1, 2, 3 and 5, respectively. Univariate analysis revealed that weight and frequency of preoperative pulmonary arterial hypertension and previous pulmonary artery banding in patients with at least moderate NAR before ASO were more than those of other patients (8.3±5.6 kgvs. 5.8±4.3 kg,P=0.006; 50.0%vs. 20.4%,P=0.001; 28.6%vs. 10.4%,P=0.013). Multivariate analysis showed that previous pulmonary artery banding (HR=3.8,P=0.005) and preoperative pulmonary arterial hypertension (HR=16.5,P<0.001) were risk factors of NAR. Conclusion The incidence of at least moderate NAR after ASO is favorable. At least moderate NAR is associated with preoperative pulmonary arterial hypertension and previous pulmonary artery banding.