Document Detail


Strategy for biventricular outflow tract reconstruction: Rastelli, REV, or Nikaidoh procedure?
MedLine Citation:
PMID:  18242263     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Three techniques have been developed as the surgical management for patients with anomalies of ventriculoarterial connection, ventricular septal defect, and pulmonary outflow tract obstruction (stenosis): the Rastelli, Lecompte, (REV), and Nikaidoh procedures. This study was designed to compare these procedures in terms of hemodynamics of the reconstructed biventricular outflow tract, early clinical consequences, and follow-up. METHODS: Between March 2004 and September 2006, a total of 30 consecutive patients underwent double root translocation procedures (modified Nikaidoh n = 11, REV n = 7, Rastelli n = 12). In the Nikaidoh procedure, both aortic and pulmonary roots were translocated. A single-valved bovine jugular vein patch was used to repair the stenotic pulmonary artery in both Nikaidoh and REV procedures. The Senning procedure was added for those with atrioventricular discordance. RESULTS: The Nikaidoh procedure was the most time-consuming in terms of mean cardiopulmonary bypass and aortic crossclamp times. The average mechanical ventilation time was significantly shorter in the Rastelli group (63.3 +/- 89 hours) than that in the Nikaidoh group (188.7 +/- 159 hours, P = .016), but not different from that in the REV group (76.4 +/- 112.5 hours, P = .395). Two patients in the REV group and 1 in the Rastelli group died. There were no in-hospital or late deaths in the Nikaidoh group. Postoperative echocardiography demonstrated physiologic hemodynamics in the left ventricular outflow tract and normal heart function in the Nikaidoh group. Abnormal flow pattern in the left ventricular outflow tract was noted in both REV and Rastelli groups. There were no late deaths or reoperations in any group during follow-up. CONCLUSION: The modified Nikaidoh procedure is a better surgical option for transposition of the great arteries, ventricular septal defect, and pulmonary stenosis in terms of physiologic cardiac hemodynamics. Its long-term benefits need to be evaluated with a larger number of patients and longer follow-up.
Authors:
Sheng-Shou Hu; Zhi-Gang Liu; Shou-Jun Li; Xiang-dong Shen; Xu Wang; Jin-ping Liu; Fu-Xia Yan; Li-qing Wang; Yong-qing Li
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-01-11
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  135     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-04     Completed Date:  2008-03-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  331-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatric Cardiovascular Surgery, The National Cardiovascular Institute and Fu Wai Hospital Beijing, Chinese Academy of Medical Science, Beijing, China. huss@vip.sohu.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Cardiac Surgical Procedures / methods*
Cardiopulmonary Bypass / methods
Child
Child, Preschool
Cohort Studies
Echocardiography, Doppler
Education, Medical, Continuing
Female
Follow-Up Studies
Heart Defects, Congenital / diagnosis,  surgery
Hemodynamics / physiology
Humans
Hypothermia, Induced
Infant
Male
Patient Selection
Reconstructive Surgical Procedures / methods*
Risk Assessment
Survival Rate
Treatment Outcome
Ventricular Outflow Obstruction / surgery*,  ultrasonography

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


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