Surgical treatment of complete transposition of great arteries with ventricular septal defect and pulmonary stenosis (TGA/VSD,PS) consists of Rastelli procedure, Lecompte procedure, Nikaidoh procedure, Yamagishi procedure and Ross-Konno switch procedure. Rastelli procedure and Lecompte procedure cause less myocardial lesion but more late complications. Nikaidoh procedure and Yamagishi procedure achieve better anatomical repair but involve more myocardial lesion. Ross-Konno switch procedure has a narrow surgical indication. So for patients with TGA/VSD,PS, different surgical methods should be used according to surgical indications and individual conditions. In this paper, the advantages and disadvantages, indication, contraindication, outcome and prospect of them are reviewed.
Abstract: The complete transposition of the great arteries (TGA) is one of the commonest congenital cardiac anomalies in cyanosis. In untreated patients, death occurs early in infancy. Nowadays arterial switch operation (ASO) has been widely proposed to treat TGA without pulmonary valve stenosis. Meanwhile, surgical risks and mortality will be increased if TGA is accompanied by coronary arterial anomalies. So proper surgical management of abnormal coronary artery has a significant influence on the outcome of ASO. The classification, operation methods and surgical results were reviewed in this article.
Corresponding author: XU Zhi-wei, E-mail: zwxumd@online.sh.cn Abstract: Objective To compare the two different ways of right ventricle pulmonary artery (RV-PA) reconstruction at repair of persistent truncus arteriosus(PTA), the direct RV-PA anastomosis and extra conduit connection, in order to find the better way. Methods From Feb. 2000 to Sept. 2006, 23 patients had undergone the repairs of truncus arteriosus in our hospital, age at operation from 1.5 to 63.3 months. Patients were divided into 2 groups according to the way of RV PA reconstruction. Group Ⅰ : 18 of them, using direct RV-PA anastomosis, group Ⅱ : 5 of them, using valved homograft or Gore-Tex conduit. 3 patients were associated with interrupted aortic arch (IAA). Kaplan-Meier was used to calculate postoperative mortality, survival time and re-operation situation. Paired t-test and group t-test were used to evaluate late pulmonary growth and cardiac function.Results There were 2 early hospital death, there were 17 patients in follow-up for 2.14 ± 1.97y (32.00d-6.95y). No later death during follow-up. Total survival rateo was 91.30%(21/23), 95% CI of survival time was 5.55-7.15y. Survival ratio of group Ⅰ was 94.40%, and that of group Ⅱ was 80%. One patient had undergone re operation for right ventricular outflow tract obstruction (RVOTO). The difference between the diameter of postoperative RV-PA anastomosis was statistically significant. The early diameter of group Ⅰ was 1.01 ± 0.26cm, later was 1.32 ± 0.45cm(P=0.019). The velocity of flow at the position of anastomosis and the peristome of right pulmonary artery (RPA)/left pulmonary artery (LPA) was acceptable. Compared the postoperative cardiac function, late left ventricle ejection fraction (LVEF) really improved with a significant difference ［ group Ⅰ , early was 62.82%, late was 69.87%(P=0.026); group Ⅱ , early was 58.17%, late was 64.00%(P=0.029) ］ . No re-operation for truncal valve regurgitation was needed. Conclusions The postoperative survival and follow-up results are satisfactory. A direct anastomosis of RV-PA continuity has the potential for right ventricle outflow tract (RVOT) growth and associated with low rate of pulmonary artery and bifurcation obstruction. The heart function is really improved during follow-up. IAA and truncal valve regurgitation are two major risk factors of associated with hospital death.
Bloodless surgery is a comprehensive and systematic perioperative treatment approach in order to avoid allogeneic transfusion for surgery，improve patient prognosis，and relieve blood shortage. Bloodless heart surgery indicates some perioperative strategies to avoid allogeneic transfusion and improve clinical outcomes，which involves participation of cardiac surgeons and other professionals during cardiac surgery. For years，many cardiac surgeons have utilized several blood management and conservation techniques during open heart surgery to avoid allogeneic transfusion. Research results from major medical centers indicate that bloodless heart surgery can shorten postoperative recovery period and improve patientprognosis. In this review，we describe basic theory and systematic methods of bloodless surgery，and summarize applicationprogress of bloodless heart surgery and current status in China.
Abstract:Objective To summarize the experiences of single stage repair of interrupted aortic arch （IAA） associated with cardiac anomalies. Methods From Jan. 2000 to Dec. 2005, 48 patients admited in hospital and 35 patients were operated, the mean age at operation was 1.1 years. The associated anomalies included 23 cases of ventricular septal defect, 2 cases of transposition of great arteries, 3 cases of aortopulmonary window with aortic origin of right pulmonary artery, 2 cases of truncus arteriosus, 2 cases of double outlet right ventricle, 2 cases of stenotic fifth arch and 1 case of aberrant origin of right subclavian artery with mild hypoplastic decending aorta. Among them, 34 patients underwent single stage repair and 1 kid underwent palliative correction. Results There were 4 surgical deaths. The sequelae included one diaphragm paralysis and one 3rd degree of atrioventricular block. Only 5 kids recurred mild stenosis of aortic arch anastomosis and 2 death occurred during 3 months to 4 years of follow-up. Conclusion Though early surgical mortality for primary single stage repair is now relatively low, if appropriate interventions has been accomplished during perioperative period, but outcomes of IAA remain of concern, especially in patients with associated lesions.
Objective To compare perioperative results between transventricular and transatrialtransventricular approaches in repairing tetralogy of Fallot (TOF), and to improve the surgical results. Methods The data of 1 423 consecutive patients who underwent complete repair of TOF between January 1998 and December 2007 were reviewed. 736 patients were repaired by the transventricular approach,and 687 patients by the transatrialtransventricular approach. Results Patients repaired by transventricular approach decreased from 100% in 1998 to 65% in 2002, and by transatrialtransventricular approach increased from 35% in 2002 to 79% in 2007. Aortic clamping time, cardiopulmonary bypass (CPB) time,mechanical ventilation time,and intensive care unit (ICU) stay in patients repaired by transatrialtransventricular approach had less than those in patients repaired by transventricular approach. No difference in transvalve patch ratio.There was lower morbidity in patients repaired by transatrialtransventricular approach in one to two organ systems dysfunction than that in patients repaired by transventricular approach. No difference in three or more organ systems dysfunction between them. Rate of residual ventricular septal defect(VSD), right ventricule to mean pulmonary artery (MPA) pressure gradient, tricuspid regurgitation, pulmonary artery regurgitation and arrhythmia in patients repaired by transatrialtransventricular approach were less than those in patients repaired by transventricular approach. Reoperative rate and mortality in patients repaired by transatrialtransventricular approach were less than those in patients repaired by transventricular approach. Conclusion TOF repair by the transatrialtransventricular approach fits to the actual conditions in China.
Objective To review and summarize the clinical outcomes of neonatal D-transposition of the great arteries by rapid two-stage arterial switch operation. Methods Between September 2002 and May 2003, five neonates with D-transposition of the great arteries were repaired by rapid two-stage arterial switch operation. The operative age was 83.0±72.2 day and weight was 4.7±0.9 kg. Because these patients came to the hospital late, the left ventricle was unable to accommodate the systemic pressure, so the left ventricle had to be prepared by pulmonary artery banding and systemic-pulmonary arterial shunt. After 6-9 days, the arterial switch procedure was performed. Results At first stage, one patient died of supraventricular tachycardia and oliguria after peritoneal dialysis. Four patients were repaired by arterial switch operation with no death. These patients were followed up for 2 to 10 months and had good development. The echocardiogram showed that there were no intracardiac residual shunt , the aorta and pulmonary artery anastomosis had no obstruction . The heart function was good, ejection fraction 0.68-0.77,fractional shortening 0.24-0.37. One patient had mild aortic valve regurgitation. Conclusion Rapid two-stage arterial switch operation is the best way for neonatal D-transposition of the great arteries that the left ventricle was unable to accommodate the systemic pressure.