Long-Term Follow-Up of the Conal Flap Method for Tricuspid Malinsertion in Transposition of the Great Arteries With Ventricular Septal Defect and Pulmonary Stenosis

Abstract

Rastelli and réparation à l'étage ventriculaire (REV) procedures have been applied for biventricular repair of transposition of great arteries with ventricular septal defects and pulmonary stenosis (TGA III). In some patients with TGA III, whose tricuspid valve (TV) chordae tendineae are attached to the infundibular septum, abnormal TV chorda insertion may cause intracardiac rerouting obstruction. For such cases, we performed a conal flap" (CF) procedure involving mobilization of the infundibular septum including TV chordae as a pedicled flap. This study evaluated the long-term outcomes of this CF method. Between October 1985 and December 1999, 17 consecutive patients with TGA III underwent a Rastelli-type or an REV-type procedure using CF. Median age at operation was 4.8 years (range, 1.5 to 14.0 years). The mean follow-up period was 17.8 ± 7.2 years. One hospital death and one late death occurred. The freedom from death rates were 94.1%, 94.1%, and 85.6% at 5, 10, and 15 years, respectively. The freedom from death or reoperation rates were 94.1%, 55.8%, and 46.5% at 5, 10, and 15 years, respectively. No reoperations were performed for the left ventricular outflow tract (LVOT) or TV. The average LVOT maximum flow velocity was 1.26 ± 0.50 m/s. TV regurgitation was greater than mild in 3 patients (20%) and trivial to mild in 12 patients (80%). Thirteen patients were in New York Heart Association (NYHA) functional class I, and 2 patients were in NYHA functional class II. The long-term outcomes, including the daily life activities, LVOT pressure gradients, and TV regurgitation grades, were excellent in patients who underwent Rastelli-type and REV-type procedures using CF for TGA III.