11. Damus–Kaye–Stansel operation versus bulboventricular foramen enlargement for the management of univentricular heart with systemic outflow obstruction: 17 years experience, a retrospective study

Abstract

Subaortic stenosis in a single ventricle morphology can be managed by a Damus–Kaye–Stansel procedure or by direct bulboventricular foramen (BVF) resection.We report our results with both techniques in our center emphasizing pros and cons of either technique. 34 cases with univentricular heart and BVF obstruction undergoing surgery for subaortic stenosis during the period between April 1997 and June 2014 were retrospectively reviewed. Group A (n = 15), receiving a Damus–Kaye–Stansel procedure and Group B (n = 19), receiving BVF enlargement. Median age and median weight at surgery were 34 months (range 7–84 months) and 11 kilograms (range 4–22 kilograms) respectively. There were two early deaths in Group A (13.3%) and one in Group B (5.3%). No patient had heart block in the Group A, while two patients had heart block in Group B (10.5%). One patient had residual left ventricular outflow obstruction after BVF enlargement that needed early re-intervention. New atrio-ventricular valve regurgitation(AVVR) occurred in one patient of Group A (moderate) and in 8 patients of Group B (mild n = 1, moderate n = 5, severe n = 2). The median length of hospital stay in Group A and Group B were 12.5 and 15 days, respectively. The mean follow up period was 72 ± 56 months (range 1–199 months). Fontan completion was achieved in 13 patients. No surgical intervention for residual systemic ventricular outflow obstruction was needed in the follow up period in either group. Although both procedures effectively relieve the obstruction in the systemic outlet chamber, direct BVF enlargement carries higher risk of heart block and new AVVR than the Damus–Kaye–Stansel procedure.