Anatomic reconstruction of biventricular outflow tract: double root translocation (DRT)

Abstract

Objective The surgical management of anomalies of ventriculoarterial with ventricular septal defect (VSD) and left ventricular outflow tract obstruction(LVOTO) continues to present a surgical challenge because of the wide variability in anatomy and the disappointing late results with current approaches.For this reason,several techniques for surgical repair have been proposed.The optimal surgical strategy remains controversial.Here we present a mid term result of an alternative solution for these anomalies by a new technique named double-root translocation.Methods Between December 2007 and September 2013,a total of 78 consecutive patients underwent a double-root translocation procedure,at a median age of 3.0 (range,0.3-22.0) years.The VSD was repaired with a dacron patch,and the aortic root translocation was done with coronary reimplantation.The neopulmonary artery was reconstructed with a monocusp bovine jugular vein patch or a homograft patch.The mean follow-up interval was 56 months (range,2 to 98 months).Biventricular outflow tract function was assessed by echocardiography.Results In-hospital mortality was 4.4％ (3 patients).The causes of death are as follows,renal failure,low cardiac output,septicemia.During the follow-up period,no patient requiring reintervention,and 2 follow-up deaths caused by heart failure and sudden death.Postoperative echocardiography showed satisfactory hemodynamic effect of the reconstructed biventricular outflow tract and ventricular function.LVOT gradient was very low,indicating that root translocation procedures offer satisfying relief of LVOT obstruction.Mean RVOT gradient was only 10.4 mmHg (1.38 kPa),and in most of cases,the pulmonary valves only present mild or moderate regurgitation.Conclusion Our strategy for RVOT reconstruction is to reconstruct a free neo-pulmonary root with a monovalve patch plus native pulmonary artery.Therefore,the competence and the growth potential of the neo-pulmonary root can be expected.The double root transloction procedure is a true-meaning anatomic repair for transposition of the great arteries or double outlet of right ventricle,with ventricular septal defect and pulmonary stenosis in terms of physiologic cardiac hemodynamics. Key words: Heart defects, congenital ; Great arteries translocation ; Double outlet of right ventricle ; Left ventricular outlet tract stenosis ; Double root translocation ; Nikaidoh procedure