Abstract 4569: What is the Best Operation for Transposition of the Great Arteries with Left Ventricular Outflow Tract Obstruction?: Midterm results

Abstract

Transposition of the great arteries (TGA) with left ventricular outflow tract obstruction (LVOTO) may be treated with arterial switch operation (ASO) with or without LVOT intervention, aortic translocation, or Rastelli operation. We evaluated mid-term results of repair for TGA/LVOTO at our institution. Patients diagnosed with TGA/LVOTO at Children’s Hospital Boston from 1995 to 2007 who underwent repair were retrospectively reviewed. LVOTO was defined as pulmonary valve (PV) z-score < −2.0 or LVOT gradient > 15 mmHg in the presence of anatomic subvalvar stenosis. Preoperative morphology of the LVOT and PV were recorded. Kaplan-Meier freedom from LVOT reintervention was compared between groups and risk factors were determined by logistic regression. 88 patients with TGA/LVOTO were repaired. Ventricular septal defect was present in 78 (89%). Patients with lower PV z-scores at presentation were more likely to undergo Rastelli or aortic translocation as opposed to ASO ± LVOT intervention. At median follow up of 2.7 years (range 8 mo to 11 yrs), all patients were alive. Patients undergoing Rastelli were more likely to require surgical reintervention for LVOTO compared to the other groups ( P =0.015, log-rank=10.49). Patients undergoing ASO alone had a higher rate of LVOT reintervention than those who had concomitant LVOT intervention ( P =NS). In those undergoing Rastelli, a higher PV z-score was a predictor of LVOT reintervention (odds ratio = 4.0, P =0.012). TGA patients with severe LVOTO who undergo Rastelli repair have a high rate of LVOT reintervention. Higher preoperative PV z-score is a risk factor for reintervention in this group. Patients with mild/moderate LVOTO undergoing ASO alone may have an increased risk of LVOT reintervention.