Document Detail


Should we address the neopulmonic valve? Significance of right-sided obstruction after surgery for transposition of the great arteries and coarctation.
MedLine Citation:
PMID:  18805180     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The combination of transposition of the great arteries and coarctation of the aorta (TGA/CoA) presents a surgical challenge. We have adopted a concurrent aortic arch repair and arterial switch operation with excellent results. These patients tend to have a small aortic (ie, neopulmonary) annulus. This study evaluates the significance of right-sided obstruction after single-stage repair of TGA/CoA. METHODS: Between May 1991 and May 2006, 53 patients with TGA/CoA or Taussig-Bing/CoA (n = 20; 38%) underwent a complete single-stage repair. Surgical technique involved the arterial switch operation and ventricular septal defect closure when present in 51 patients (96%). The aortic arch was enlarged in 36 patients (75%) with patch augmentation. Two patients (4%) underwent the augmentation of the right ventricular outflow tract (RVOT) at the first operation. RESULTS: There was one hospital death (operative mortality, 1.9%) and one late death. The difference between the preoperative aortic and pulmonary annulus was significant (6.7 vs 10.4 mm, p < 0.001). The peak pressure gradient across the proximal RVOT at discharge was 16 +/- 16 mm Hg (range, 0 to 62 mm Hg). There have been six reoperations (11%) and four catheter interventions (7.5%) for right-sided obstruction. Freedom from reintervention/reoperation for right-sided obstruction at 1, 5, and 10 years is 95%, 87%, and 80%, respectively. CONCLUSIONS: Neonatal single-stage repair for TGA/CoA achieves excellent survival without transannular patch repair at the first operation. Although some of the patients have pressure gradient across the RVOT, these lesions were amenable to reintervention with minimal morbidity.
Authors:
Yasutaka Hirata; Jonathan M Chen; Jan M Quaegebeur; Ralph S Mosca
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  86     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-09-22     Completed Date:  2008-10-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1293-8; discussion 1298     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. yh2240@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Anastomosis, Surgical / adverse effects,  methods
Aortic Coarctation / diagnosis,  mortality,  surgery*
Cardiopulmonary Bypass / methods
Confidence Intervals
Education, Medical, Continuing
Female
Heart Defects, Congenital / diagnosis,  mortality,  surgery
Humans
Infant
Infant, Newborn
Kaplan-Meiers Estimate
Logistic Models
Male
Postoperative Complications / mortality,  physiopathology
Probability
Pulmonary Valve*
Registries
Reoperation
Retrospective Studies
Risk Assessment
Survival Rate
Transposition of Great Vessels / diagnosis,  mortality,  surgery*
Vascular Surgical Procedures / adverse effects*,  methods
Ventricular Outflow Obstruction / etiology*,  prevention & control,  surgery

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


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