• J. Thorac. Cardiovasc. Surg. · Nov 2022

    Multicenter Study Observational Study

    Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study.

    • Serban Stoica, Michaela Kreuzer, Dan-Mihai Dorobantu, Martin Kostolny, Matej Nosal, Amir-Reza Hosseinpour, Fernando Laviana Martinez, Tommaso Generali, Asif Hasan, Rudolf Mair, and Mark Hazekamp.
    • University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom. Electronic address: Serban.Stoica@uhbw.nhs.uk.
    • J. Thorac. Cardiovasc. Surg. 2022 Nov 1; 164 (5): 1249-1260.

    ObjectiveThere are several choices for the correction of complex transposition of the great arteries and double outlet right ventricle not amenable to the Rastelli-type surgery, but outcome data are limited to small series. This study aims to report results after the aortic root translocation and en bloc rotation of the outflow tract procedures.MethodsThis is a retrospective, multicentric, observational study. Clinical, anatomy, procedural, and detailed follow-up data (median, 4.43 years) were collected.ResultsA total of 70 patients (62.9% male; median age, 1 year; range 4 days to 12.4 years) were included: n = 43 in the aortic root translocation group and n = 27 in the en bloc rotation group. Those in the aortic root translocation group were older (P = .01) and more likely to have had previous procedures (P < .0001), but cardiac anatomy was similar in both groups. Aortic root translocation and en bloc rotation early mortality (30 days) was similar (4.7% vs 3.7%, P = .8). Late survival and freedom from any cardiac reintervention were 92.7% and 16.9% at 15 years overall, respectively. Freedom from right ventricular outflow tract/conduit reintervention was better in the en bloc rotation group than in the aortic root translocation group (100% vs 24.5%, P = .0003), but more patients in the en bloc rotation group had moderate (or worse) aortic valve regurgitation during follow-up (16% vs 2.6%, P = .07).ConclusionsBoth aortic root translocation and en bloc rotation are valuable surgical options for the treatment of complex transposition of the great arteries and double outlet right ventricle. In the en bloc rotation group, there was better freedom from right ventricular outflow tract reinterventions, but a higher probability of aortic valve regurgitation. Identifying the main driving forces for these observed differences requires further study of these procedures.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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