Abstract | OBJECTIVE: METHODS: 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.
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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 |
Journal | The Journal of thoracic and cardiovascular surgery
(J Thorac Cardiovasc Surg)
Vol. 134
Issue 4
Pg. 967-973.e6
(Oct 2007)
ISSN: 1097-685X [Electronic] United States |
PMID | 17903515
(Publication Type: Journal Article)
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Topics |
- 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
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