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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Aortic Root Translocation Plus Arterial Switch for Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction

Intermediate-Term Results

Department of Cardiac Surgery, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts.

Manuscript received May 30, 2006; revised manuscript received September 8, 2006, accepted September 11, 2006.

^_* Reprint requests and correspondence: Dr. Pedro J. del Nido, Department of Cardiovascular Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Bader 273, Boston, Massachusetts 02115. (Email: pedro.delnido{at}tch.harvard.edu).

Presented at the Fourth World Congress of Pediatric Cardiology and Cardiac Surgery, September 18 to 23, 2005, Buenos Aires, Argentina.

OBJECTIVES: The goal of our study was to report our intermediate-term results with aortic root translocation plus arterial switch for d-transposition of the great arteries with left ventricular outflow tract obstruction.

BACKGROUND: A d-transposition of the great arteries with left ventricular outflow tract obstruction represents a difficult surgical problem. The Rastelli procedure is the usual approach to this condition. However, recurrent left ventricular outflow tract obstruction and early conduit obstruction as well as arrhythmias and troublesome late mortality are significant limitations.

METHODS: From 1993 to 2005, 11 children (8 male, 3 female) ages 1 month to 11 years (median age 7 months) have undergone aortic root autograft translocation plus arterial switch to correct d-transposition of the great arteries with left ventricular outflow tract obstruction. The native aortic root was excised from the right ventricle infundibulum and inserted into the left ventricular outflow, enlarging the outflow tract by resecting the outlet septum and an appropriate-size ventricular septal defect patch. After coronary artery reimplantation, right ventricular outflow reconstruction was achieved with a homograft.

RESULTS: There were no early or late deaths. With a median follow-up of 59 months (range 2 to 137 months), 5 patients required 6 conduit replacement procedures at a median time of 53 months. Two patients required an implantable defibrillator for ventricular arrhythmias. None of the patients have developed left ventricular outflow tract obstruction.

CONCLUSIONS: Aortic root autograft plus arterial switch procedure is a good option for the surgical management of infants and children with d-transposition of the great arteries and left ventricular outflow tract obstruction and results in a more anatomic repair compared with Rastelli operation. Intermediate-term results indicate good relief of left ventricular outflow tract obstruction and need for conduit replacement compares favorably with the Rastelli procedure for this lesion.

Abbreviations and Acronyms   d-TGA = d-transposition of the great arteries   DORV = double-outlet right ventricle   LV = left ventricle/ventricular   LVOTO = left ventricular outflow tract obstruction   PA = pulmonary artery   RV = right ventricle/ventricular   VSD = ventricular septal defect

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