Double-Root Translocation for Double-Outlet Right Ventricle With Noncommitted Ventricular Septal Defect or Double-Outlet Right Ventricle With Subpulmonary Ventricular Septal Defect Associated With Pulmonary Stenosis: An Optimized Solution

Abstract

Biventricular repair of double-outlet right ventricle (DORV) with noncommitted ventricular septal defect (VSD) or subpulmonary VSD, associated with pulmonary stenosis, remains controversial. The usual technique, Rastelli or réparation à l'étage ventriculaire (REV) procedure, may not meet a perfect biventricular outflow tract reconstruction in terms of hemodynamic performance and long-term outcome. Here we present an early result of an alternative solution for these anomalies by double-root translocation technique. Between August 2006 and August 2009, a total of 10 consecutive patients underwent a double-root translocation procedure, at a median age of 48 +/- 55 months (range, 1 to 16 years). The VSD was repaired with a Dacron patch, and VSD enlargement was done in 3 patients. The aortic translocation was done with (n = 4) or without (n = 6) coronary reimplantation. The neopulmonary artery was reconstructed with a monocusp bovine jugular vein patch (n = 8) or a homograft patch (n = 2). The mean follow-up interval was 21.9 +/- 11 months (range, 2 to 36). Biventricular outflow tract function was assessed by echocardiography. There were no early or late deaths, and no required reoperations. Two patients required early support by extracorporeal membrane oxygenation. Postoperative echocardiography showed satisfactory hemodynamic effect of the reconstructed biventricular outflow tract and ventricular function. One patient had trivial aortic regurgitation and 4 patients had trivial or mild pulmonary insufficiency in follow-up. The early results showed an optimized solution for DORV with noncommitted VSD or DORV with subpulmonary VSD, associated with pulmonary stenosis. Long-term benefits need to be evaluated with a larger number of patients and longer follow-up.