TY - JOUR
T1 - TGA + IVS + LVOTO
T2 - Patterns of practice and outcomes
AU - Esmaeil, Husain
AU - Jacobs, Jeffrey P.
AU - Tchervenkov, Christo I.
AU - Kansy, Andrzej
AU - Maruszewski, Bohdan
AU - Tobota, Zdzislaw
AU - St. Louis, James D.
AU - Kirklin, James K.
AU - Overman, David M.
AU - Vida, Vladimiro
AU - Herbst, Claudia
AU - Ashfaq, Awais
AU - Al-Halees, Zohair
AU - Sarris, George E.
N1 - Publisher Copyright:
© The Author(s), 2023. Published by Cambridge University Press.
PY - 2023/3/17
Y1 - 2023/3/17
N2 - Purpose: Transposition of great arteries with intact ventricular septum and left ventricular outflow tract obstruction (TGA + IVS + LVOTO) is uncommon. We reviewed operations performed in patients with TGA + IVS + LVOTO in the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD). Methods: All 109 patients with a diagnosis of TGA + IVS + LVOTO in ECHSA-CD who underwent cardiac surgery during a 21-year period (01/2000-02/2021, inclusive) were included. Preoperative variables, operative data, and postoperative outcomes were collected. Results: These 109 patients underwent 176 operations, including 37 (21.0%) arterial switch operations (ASO), 26 (14.2%) modified Blalock-Taussig-Thomas shunts (MBTTS), 11 (6.2%) Rastelli operations, and 13 (7.3%) other palliative operations (8 superior cavopulmonary anastomosis[es], 4 Fontan, and 1 other palliative procedure). Of 37 patients undergoing ASO, 22 had a concomitant procedure. There were 68 (38.6%) reoperations, including 11 pacemaker procedures and 8 conduit operations. After a systemic-to-pulmonary artery shunt, reoperations included shunt reoperation (n = 4), Rastelli (n = 4), and superior cavopulmonary anastomosis (n = 3). Overall Operative Mortality was 8.2% (9 deaths), including three following ASO, two following Nikaidoh, Kawashima, or LV-PA conduit procedures, and two following Rastelli. Postoperative complications occurred after 36 operations (20.4%). The most common complications were delayed sternal closure (n = 11), postoperative respiratory insufficiency requiring mechanical ventilation >7 days (n = 9), and renal failure requiring temporary dialysis (n = 8). Conclusion: TGA + IVS + LVOTO is rare (109 patients in ECHSA-CD over 21 years). ASO, MBTTS, and Rastelli are the most common operations performed for TGA + IVS + LVOTO. Larger international studies with long-term follow-up are needed to better define the anatomy of the LVOTO and to determine the optimal surgical strategy.
AB - Purpose: Transposition of great arteries with intact ventricular septum and left ventricular outflow tract obstruction (TGA + IVS + LVOTO) is uncommon. We reviewed operations performed in patients with TGA + IVS + LVOTO in the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD). Methods: All 109 patients with a diagnosis of TGA + IVS + LVOTO in ECHSA-CD who underwent cardiac surgery during a 21-year period (01/2000-02/2021, inclusive) were included. Preoperative variables, operative data, and postoperative outcomes were collected. Results: These 109 patients underwent 176 operations, including 37 (21.0%) arterial switch operations (ASO), 26 (14.2%) modified Blalock-Taussig-Thomas shunts (MBTTS), 11 (6.2%) Rastelli operations, and 13 (7.3%) other palliative operations (8 superior cavopulmonary anastomosis[es], 4 Fontan, and 1 other palliative procedure). Of 37 patients undergoing ASO, 22 had a concomitant procedure. There were 68 (38.6%) reoperations, including 11 pacemaker procedures and 8 conduit operations. After a systemic-to-pulmonary artery shunt, reoperations included shunt reoperation (n = 4), Rastelli (n = 4), and superior cavopulmonary anastomosis (n = 3). Overall Operative Mortality was 8.2% (9 deaths), including three following ASO, two following Nikaidoh, Kawashima, or LV-PA conduit procedures, and two following Rastelli. Postoperative complications occurred after 36 operations (20.4%). The most common complications were delayed sternal closure (n = 11), postoperative respiratory insufficiency requiring mechanical ventilation >7 days (n = 9), and renal failure requiring temporary dialysis (n = 8). Conclusion: TGA + IVS + LVOTO is rare (109 patients in ECHSA-CD over 21 years). ASO, MBTTS, and Rastelli are the most common operations performed for TGA + IVS + LVOTO. Larger international studies with long-term follow-up are needed to better define the anatomy of the LVOTO and to determine the optimal surgical strategy.
KW - Rastelli operation
KW - Transposition of great arteries
KW - arterial switch operation
KW - left ventricular outflow obstruction
UR - http://www.scopus.com/inward/record.url?scp=85150311635&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150311635&partnerID=8YFLogxK
U2 - 10.1017/S1047951122003924
DO - 10.1017/S1047951122003924
M3 - Article
C2 - 36799034
AN - SCOPUS:85150311635
SN - 1047-9511
VL - 33
SP - 342
EP - 348
JO - Cardiology in the young
JF - Cardiology in the young
IS - 3
ER -