Outcome of Left Ventricular Outlet Tract and Aortic Valve Function after Arterial Switch Operation for Patients with Transposition of the Great Arteries and Left Ventricular Outlet Tract Obstruction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHANGYi , GAOHua-wei , YANJun , HUAZhong-dong , ZHANGHao , YANGKe-ming , CHUJun-min ,  LIShou-jun

Pediatric cardiovascular Institute, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P. R. China;

Corresponding author：

LIShou-jun, Email: drlishoujun@yahoo.com

Keywords：

Transposition of the great arteries; Left ventricular outlet tract obstruction; Arterial switch operation

DOI：

10.7507/1007-4848.20150035

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Objective To assess the function of left ventricular outlet tract and aortic valve after arterial switch operation (ASO) for patients with transposition of the great arteries (TGA) and left ventricular outlet tract obstruction (LVOTO). Methods From 2002 to 2013, 549 pediatric TGA patients received ASO in Fu Wai Hospital. Among them, 42 patients had LVOTO, including 31 males and 11 females with their median age of 12 months (range, 7 days to 96 months), median body weight of 6.5(3.5-26.0) kg and percutaneous oxygen saturation of 52%-85%. LVOTO anomalies included pulmonary valve stenosis, subaortic membrane, tunnel-like subaortic stenosis, muscular subaortic stenosis, subvalvular apparatus and combined anomalies. Different surgical procedures were performed according to respective anomalies. Echocardiographic characteristics, intraoperative findings, surgical methods, early and follow-up results were summarized. Results Cardiopulmonary bypass time was 147-344 (193.5±73.1) minutes, mean aortic cross-clamping time was 139(109-305) minutes, mean mechanical ventilation time was 36(3-960) hours, and mean length of ICU stay was 5(1-48) days. Three patients received and later successfully weaned from extracorporeal membrane oxygenation. Two patients died postoperatively including 1 patient with multiple organ dysfunction syndrome and another patient with severe infection. One patient died during follow-up for unknown reason, and 3 patients were lost during followup. Thirty-six patients were followed up for 24 (3-116) months. During follow-up, there were 1 patient with LVOTO recurrence, 1 patient with new-onset mild aortic valve stenosis, 11 patients with new-onset mild aortic regurgitation (AR), and 2 patients with new-onset moderate AR. Median systolic left ventricular-aortic pressure gradient[4 (2-49) mm Hg] was significantly lower than preoperative value[37.2 (12.1-70.6) mm Hg] (Z=-5.153). Cardiac event-free rate was 91%±5% at 1 year and 78%±8% at 5 years after discharge. Conclusion For TGA patients with LVOTO, ASO can produce satisfactory mid-and long-term results if proper surgical indications and strategies are chosen according to different severity of LVOTO which can be evaluated by anatomic features of TGA and systolic left ventricular-aortic pressure gradient.

Citation： CHANGYi, GAOHua-wei, YANJun, HUAZhong-dong, ZHANGHao, YANGKe-ming, CHUJun-min, LIShou-jun. Outcome of Left Ventricular Outlet Tract and Aortic Valve Function after Arterial Switch Operation for Patients with Transposition of the Great Arteries and Left Ventricular Outlet Tract Obstruction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(2): 123-127. doi: 10.7507/1007-4848.20150035 Copy

1.	Sarris GE, Chatzis AC, Giannopoulos NM, et al. The arterial switch operation in Europe for transposition of the great arteries:a multiinstitutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg, 2006, 132(3):633-639.
2.	Shribastava S, Tadavarthy SM, Fukuda T, et al. Anatomic causes of pulmonary stenosis in complete transposition. Circulation, 1976, 54(1):154-159.
3.	Wernovsky G, Jonas RA, Colan SD, et al. Results of the arterial switch operation in patients with transposition of the great arteries and abnormalities of the mitral valve or left ventricular outflow tract. J Am Coll Cardiol, 1990, 16(6):1446-1454.
4.	Rastelli GC, Mcgoon DC, Wallace RB. Anatomic correction of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis. J Thorac Cardiovasc Surg, 1969, 58(4):545-552.
5.	Lecompte Y, Neveux JY, Leca F, et al. Reconstruction of the pulmonary outflow tract without prosthetic conduit. J Thorac Cardiovasc Surg, 1982, 84(5):727-733.
6.	Nikaidoh H. Aortic translocation and biventricular outflow tract reconstruction. A new surgical repair for transposition of the great arteries associated with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg, 1984, 88(3):365-372.
7.	Hu S, Liu Z, Li S, et al. Strategy for biventricular outflow tract reconstruction:Rastelli, REV, or Nikaidoh procedure? J Thorac Cardiovasc Surg, 2008, 135(2):331-338.
8.	Zilberman MV, Khoury PR, Kimball RT. Two-dimensional echocardiographic valve measurements in healthy children:Gender-specific differences. Pediatr Cardiol, 2005, 26(4):356-360.
9.	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.
10.	Dearani JA, Danielson GK, Puga FJ, et al. Late results of the Rastelli operation for transposition of the great arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2001, 4:3-15.
11.	Morell VO, Jacobs JP, Quintessenza JA. Aortic translocation in the management of transposition of the great arteries with ventricular septal defect and pulmonary stenosis:results and follow-up. Ann Thorac Surg, 2005, 79(6):2089-2092.
12.	Yeh J, Ramaciotti C, Leonard SR, et al. The aortic translocation (Nikaidoh) procedure:Midterm results superior to the Rastelli procedure. J Thorac Cardiovasc Surg, 2007, 133(2):461-469.
13.	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.
14.	Park CS, Seo DM, Park JJ, et al. The significance of pulmonary annulus size in the surgical management of transposition of the great arteries with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg, 2010, 139(1):135-138.
15.	Sohn YS, Brizard CP, Cochrane AD, et al. Arterial switch in hearts with left ventricular outflow and pulmonary valve abnormalities. Ann Thorac Surg, 1998, 66(3):842-848.
16.	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.
17.	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.
18.	Uemura H, Yagihara T, Kawashima Y, et al. A bicuspid pulmonary valve is not a contraindication for the arterial switch operation. Ann Thorac Surg, 1995, 59(2):473-476.

1. Sarris GE, Chatzis AC, Giannopoulos NM, et al. The arterial switch operation in Europe for transposition of the great arteries:a multiinstitutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg, 2006, 132(3):633-639.
2. Shribastava S, Tadavarthy SM, Fukuda T, et al. Anatomic causes of pulmonary stenosis in complete transposition. Circulation, 1976, 54(1):154-159.
3. Wernovsky G, Jonas RA, Colan SD, et al. Results of the arterial switch operation in patients with transposition of the great arteries and abnormalities of the mitral valve or left ventricular outflow tract. J Am Coll Cardiol, 1990, 16(6):1446-1454.
4. Rastelli GC, Mcgoon DC, Wallace RB. Anatomic correction of transposition of the great arteries with ventricular septal defect and subpulmonary stenosis. J Thorac Cardiovasc Surg, 1969, 58(4):545-552.
5. Lecompte Y, Neveux JY, Leca F, et al. Reconstruction of the pulmonary outflow tract without prosthetic conduit. J Thorac Cardiovasc Surg, 1982, 84(5):727-733.
6. Nikaidoh H. Aortic translocation and biventricular outflow tract reconstruction. A new surgical repair for transposition of the great arteries associated with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg, 1984, 88(3):365-372.
7. Hu S, Liu Z, Li S, et al. Strategy for biventricular outflow tract reconstruction:Rastelli, REV, or Nikaidoh procedure? J Thorac Cardiovasc Surg, 2008, 135(2):331-338.
8. Zilberman MV, Khoury PR, Kimball RT. Two-dimensional echocardiographic valve measurements in healthy children:Gender-specific differences. Pediatr Cardiol, 2005, 26(4):356-360.
9. 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.
10. Dearani JA, Danielson GK, Puga FJ, et al. Late results of the Rastelli operation for transposition of the great arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2001, 4:3-15.
11. Morell VO, Jacobs JP, Quintessenza JA. Aortic translocation in the management of transposition of the great arteries with ventricular septal defect and pulmonary stenosis:results and follow-up. Ann Thorac Surg, 2005, 79(6):2089-2092.
12. Yeh J, Ramaciotti C, Leonard SR, et al. The aortic translocation (Nikaidoh) procedure:Midterm results superior to the Rastelli procedure. J Thorac Cardiovasc Surg, 2007, 133(2):461-469.
13. 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.
14. Park CS, Seo DM, Park JJ, et al. The significance of pulmonary annulus size in the surgical management of transposition of the great arteries with ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg, 2010, 139(1):135-138.
15. Sohn YS, Brizard CP, Cochrane AD, et al. Arterial switch in hearts with left ventricular outflow and pulmonary valve abnormalities. Ann Thorac Surg, 1998, 66(3):842-848.
16. 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.
17. 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.
18. Uemura H, Yagihara T, Kawashima Y, et al. A bicuspid pulmonary valve is not a contraindication for the arterial switch operation. Ann Thorac Surg, 1995, 59(2):473-476.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Outcome of Left Ventricular Outlet Tract and Aortic Valve Function after Arterial Switch Operation for Patients with Transposition of the Great Arteries and Left Ventricular Outlet Tract Obstruction

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