Document Detail


Determinants of repair type, reintervention, and mortality in 393 children with double-outlet right ventricle.
MedLine Citation:
PMID:  17903515     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We sought to define the prevalence of definitive end-states and their determinants in children with double-outlet right ventricle. METHODS: We performed a clinical record review of 393 children with double-outlet right ventricle presenting to our institution from 1980 to 2000. RESULTS: Double-outlet right ventricle classification was as follows: subaortic ventricular septal defect with or without pulmonary stenosis in 47%, subpulmonic ventricular septal defect in 23%, noncommitted ventricular septal defect in 26%, and doubly committed ventricular septal defect in 4%. Hypoplastic ventricles were present in 39%, pulmonary stenosis was present in 65%, and aortic arch obstruction was present in 24%. Biventricular repair was performed in 194 patients (55%) at a median age of 10 months (range: birth to 14.0 years), and the Fontan operation (n = 182; 23%) was performed at a median age of 3.7 years (range: 6 months to 14.9 years). Results improved over time (P < .001). Factors discriminating among end-states included younger patient age at presentation (P < .001), lower weight (P < .001), and adequacy of left-sided heart structures, especially the size of the left ventricle (P < .001), aortic arch (P < .001), and mitral valve (P = .004). For complex double-outlet right ventricle, Rastelli-type repair increased early reintervention risk (P = .04) and late post-repair mortality (P = .02), whereas the arterial switch operation increased early post-repair mortality (P = .02) with a benefit of improved late post-repair survival. CONCLUSIONS: Biventricular repair, especially Rastelli-type reconstruction, is associated with higher late mortality and reintervention than is Fontan repair. The wisdom of extending biventricular repair to borderline anatomic candidates with hypoplastic left-sided structures or a nonsubaortic ventricular septal defect is questionable.
Authors:
Timothy J Bradley; Tara Karamlou; Alex Kulik; Bojana Mitrovic; Trisha Vigneswaran; Salima Jaffer; Patrick D Glasgow; William G Williams; Glen S Van Arsdell; Brian W McCrindle
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  134     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-01     Completed Date:  2007-11-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  967-973.e6     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Cardiac Surgical Procedures / methods*,  mortality
Chi-Square Distribution
Child
Child, Preschool
Double Outlet Right Ventricle / mortality,  surgery*
Female
Humans
Infant
Infant, Newborn
Male
Regression Analysis
Reoperation
Risk Factors
Statistics, Nonparametric
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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