Document Detail


Intermediate-term clinical outcomes of primary biventricular repair for left ventricular outflow tract obstruction and ventricular septal defect.
MedLine Citation:
PMID:  20621315     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Primary biventricular repair for left ventricular outflow tract obstruction and ventricular septal defect remains challenging. The intermediate-term outcomes and risk factors for mortality remain undefined.
METHODS: All patients undergoing primary biventricular repair of left ventricular outflow tract obstruction and ventricular septal defect from 1995 to 2008 at the C. S. Mott Children's Hospital, University of Michigan Health Systems were analyzed.
RESULTS: Thirty-one patients (mean age, 18 days; 20 male) with a median follow-up of 6.7 years (range, 0.3-13.5 years) were identified. The ventricular septal defect was enlarged in 15 patients, and a limited atrial septal defect was constructed in 16 patients. There were 6 hospital and 2 late deaths. Ten-year patient survival was 72.3%. Lower body weight (P = .040), complete atrial septal defect closure (P = .026), and longer cardiopulmonary bypass time (P = .026) were risk factors of hospital mortality. An atrial septal defect was patent in 16 patients at discharge, 2 of whom required later surgical closure. Relief of recurrent left ventricular outflow tract obstruction was performed in 1 patient. No patient required pacemaker implantation. Five-year freedom from right ventricle-to-pulmonary artery conduit replacement was 39.3%. Smaller-sized conduit (P = .020) and use of aortic allograft (P = .048) were risk factors for early failure.
CONCLUSION: Primary biventricular repair for patients with left ventricular outflow tract obstruction and ventricular septal defect provides good early and intermediate-term outcomes. Maintaining a small atrial septal defect may improve hospital mortality. Selective ventricular septal defect enlargement and careful construction of the intraventricular pathway result in a low incidence of recurrent left ventricular outflow tract obstruction, as well as avoidance of heart block. Maximizing valve diameter and avoiding aortic allografts may lengthen conduit longevity.
Authors:
Takaya Hoashi; Edward L Bove; Eric J Devaney; Jennifer C Hirsch; Richard G Ohye
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  141     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-20     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  200-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Pediatric Cardiovascular Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich, USA.
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MeSH Terms
Descriptor/Qualifier:
Aorta / transplantation
Cardiac Surgical Procedures* / adverse effects,  mortality
Female
Heart Septal Defects, Atrial / complications,  surgery
Heart Septal Defects, Ventricular / complications,  mortality,  surgery*
Hospital Mortality
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Male
Michigan
Norwood Procedures
Proportional Hazards Models
Pulmonary Artery / surgery
Recurrence
Risk Assessment
Risk Factors
Time Factors
Transplantation, Homologous
Treatment Outcome
Ventricular Outflow Obstruction / etiology,  mortality,  surgery*

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


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