The operative strategy after palliative shunt for corrected transposition of great artery (cTGA) with left ventricular outflow tract obstruction and cardiac malpostion_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Rui , PANG Kunjing ,  LI Shoujun , ZHANG Benqing , RUI Lu , LIN Ye , MA Kai , LI Hanmei

Department of Pediatric Cardiac Surgery of Fuwai Hospital, National Center for Cardiovdscular Diseases, Beijing Union Medical College, Chinese Academy of Medical Sciences, 100037, Beijing, P.R.China;

Corresponding author：

LI Shoujun, Email: drlishoujun@yahoo.com

Keywords：

Cardiac malpositon; corrected transposition of great artery (cTGA); secondary surgery; left ventricular outflow tract obstruction

DOI：

10.7507/1007-4848.202003048

Video：

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Objective To explore the operative strategy after palliative shunt for correcting congenitally corrected transposition of great artery (cTGA) patients with left ventricular outflow tract obstruction (LVOTO) and cardiac malpostion.Methods We retrospectively analyzed the clinical data of 54 patients with onsecutive cTGA with LVOTO and cardiac malpositon from June 2011 to May 2019. The patients were devided into two groups. There were 24 patients (16 males and 8 females at mean age of 5.4±2.2 years) who underwent one and a half ventricle repair as a one and half ventricle group. And there were 30 patients (19 males and 11 females at age of 8.6±6.2 years) who underwent one ventricle repair operation as a one ventricle group. Follow-up data were collected by telephone interviews.Results There was no statistical difference in systemic atrioventricular valve regurgitation and systemic ventricular ejection fraction between the two groups (P>0.05). Compared with one and a half ventricle group, the cardiopulmonary bypass time (CPB) time, mechanical ventilation time and intensive care unit stay were significant shorter than those in the one ventricle group (P<0.05), but prolonged pleural effusions developed more frequently in the one ventricle repair group (P<0.05). There was no in-hospital death but 1 follow-up death in each group. The follow-up time was 49 (17-38) months in the one and half ventricle group at follow-up rate of 93.9%, and 47 (12-85) months at follow-up rate at 90.9% in the one ventricle group. One and a half ventricle group had better systemic ventricular ejection fraction (EF) than that in the one ventricle repair group. And the rate of heart function (NYHA) class Ⅲ and class Ⅳ in one and a half ventricle group was lower than that in the ventricle group. No significant difference of survival and freedom from re-intervention probability between the two groups was found.Conclusion For patients of correction of cTGA with LVOTO and cardiac malposition after palliative shunt, the one-and-a-half ventricular repair procedure is ideal operative strategy.

Citation： LIU Rui, PANG Kunjing, LI Shoujun, ZHANG Benqing, RUI Lu, LIN Ye, MA Kai, LI Hanmei. The operative strategy after palliative shunt for corrected transposition of great artery (cTGA) with left ventricular outflow tract obstruction and cardiac malpostion. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(4): 447-452. doi: 10.7507/1007-4848.202003048 Copy

1.	Acar P, Bonnet D, Aggoun Y, et al. Double discordances with ventricular septal defect and pulmonary obstruction, A study of 72 cases. Arch Mal Coeur Vaiss, 1997, 90(5): 625-629.
2.	Adachi O, Masaki N, Kawatsu S, et al. Long-term results after physiologic repair for congenitally corrected transposition of the great arteries. Gen Thorac Cardiovasc Surg, 2016, 64(12): 715-721.
3.	Shin’oka T, Kurosawa H, Imai Y, et al. Outcomes of definitive surgical repair for congenitally corrected transposition of the great arteries or double outlet right ventricle with discordant atrioventricular connections: risk analyses in 189 patients. J Thorac Cardiovasc Surg, 2007, 133(5): 1318-1328.
4.	Graham TP Jr, Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study. J Am Coll Cardiol, 2000, 36(1): 255-261.
5.	Hirose K, Nishina T, Kanemitsu N, et al. The long-term outcomes of physiologic repair for ccTGA (congenitally corrected transposition of the great arteries). Gen Thorac Cardiovasc Surg, 2015, 63(9): 496-501.
6.	Gewillig M, Goldberg DJ. Failure of the Fontan circulation. Heart Fail Clin, 2014, 10(1): 105-116.
7.	Goldberg DJ, Surrey LF, Glatz AC, et al. Hepatic fibrosis is universal following fontan operation, and severity is associated with time from surgery: A liver biopsy and hemodynamic study. J Am Heart Assoc, 2017, 6(5): e004809.
8.	Malhotra SP, Reddy VM, Qiu M, et al. The hemi-Mustard/bidirectional Glenn atrial switch procedure in the double-switch operation for congenitally corrected transposition of the great arteries: rationale and midterm results. J Thorac Cardiovasc Surg, 2011, 141(1): 162-170.
9.	杨克明, 郑帅, 花中东, 等. 一个半心室治疗的新领域——心脏位置异常的复杂矫正型大动脉转位矫治术. 中国胸心血管外科临床杂志, 2012, 19(2): 193-196.
10.	Zhang S, Ma K, Li S, et al. The hemi-Mustard, bidirectional Glenn and Rastelli procedures for anatomical repair of congenitally corrected transposition of the great arteries/left ventricular outflow tract obstruction with positional heart anomalies. Eur J Cardiothorac Surg, 2017, 51(6): 1058-1062.
11.	Hörer J, Schreiber C, Krane S, et al. Outcome after surgical repair/palliation of congenitally corrected transposition of the great arteries. Thorac Cardiovasc Surg, 2008, 56(7): 391-397.
12.	何晓敏, 郑景浩, 罗凯, 等. 先天性矫正型大动脉转位解剖纠治的外科策略及十年随访的回顾性队列研究. 中国胸心血管外科临床杂志, 2020, 27(3): 255-259.
13.	Hraska V, Duncan BW, Mayer JE Jr, et al. Long-term outcome of surgically treated patients with corrected transposition of the great arteries. J Thorac Cardiovasc Surg, 2005, 129(1): 182-191.
14.	Miyaji K, Shimada M, Sekiguchi A, et al. Pulmonary atresia with intact ventricular septum: long-term results of “one and a half ventricular repair”. Ann Thorac Surg, 1995, 60(6): 1762-1764.
15.	吕小东, 杨克明, 李守军, 等. 阜外医院71例Rastelli手术的近中期结果. 中华胸心血管外科杂志, 2020, 36(1): 5-9.

1. Acar P, Bonnet D, Aggoun Y, et al. Double discordances with ventricular septal defect and pulmonary obstruction, A study of 72 cases. Arch Mal Coeur Vaiss, 1997, 90(5): 625-629.
2. Adachi O, Masaki N, Kawatsu S, et al. Long-term results after physiologic repair for congenitally corrected transposition of the great arteries. Gen Thorac Cardiovasc Surg, 2016, 64(12): 715-721.
3. Shin’oka T, Kurosawa H, Imai Y, et al. Outcomes of definitive surgical repair for congenitally corrected transposition of the great arteries or double outlet right ventricle with discordant atrioventricular connections: risk analyses in 189 patients. J Thorac Cardiovasc Surg, 2007, 133(5): 1318-1328.
4. Graham TP Jr, Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study. J Am Coll Cardiol, 2000, 36(1): 255-261.
5. Hirose K, Nishina T, Kanemitsu N, et al. The long-term outcomes of physiologic repair for ccTGA (congenitally corrected transposition of the great arteries). Gen Thorac Cardiovasc Surg, 2015, 63(9): 496-501.
6. Gewillig M, Goldberg DJ. Failure of the Fontan circulation. Heart Fail Clin, 2014, 10(1): 105-116.
7. Goldberg DJ, Surrey LF, Glatz AC, et al. Hepatic fibrosis is universal following fontan operation, and severity is associated with time from surgery: A liver biopsy and hemodynamic study. J Am Heart Assoc, 2017, 6(5): e004809.
8. Malhotra SP, Reddy VM, Qiu M, et al. The hemi-Mustard/bidirectional Glenn atrial switch procedure in the double-switch operation for congenitally corrected transposition of the great arteries: rationale and midterm results. J Thorac Cardiovasc Surg, 2011, 141(1): 162-170.
9. 杨克明, 郑帅, 花中东, 等. 一个半心室治疗的新领域——心脏位置异常的复杂矫正型大动脉转位矫治术. 中国胸心血管外科临床杂志, 2012, 19(2): 193-196.
10. Zhang S, Ma K, Li S, et al. The hemi-Mustard, bidirectional Glenn and Rastelli procedures for anatomical repair of congenitally corrected transposition of the great arteries/left ventricular outflow tract obstruction with positional heart anomalies. Eur J Cardiothorac Surg, 2017, 51(6): 1058-1062.
11. Hörer J, Schreiber C, Krane S, et al. Outcome after surgical repair/palliation of congenitally corrected transposition of the great arteries. Thorac Cardiovasc Surg, 2008, 56(7): 391-397.
12. 何晓敏, 郑景浩, 罗凯, 等. 先天性矫正型大动脉转位解剖纠治的外科策略及十年随访的回顾性队列研究. 中国胸心血管外科临床杂志, 2020, 27(3): 255-259.
13. Hraska V, Duncan BW, Mayer JE Jr, et al. Long-term outcome of surgically treated patients with corrected transposition of the great arteries. J Thorac Cardiovasc Surg, 2005, 129(1): 182-191.
14. Miyaji K, Shimada M, Sekiguchi A, et al. Pulmonary atresia with intact ventricular septum: long-term results of “one and a half ventricular repair”. Ann Thorac Surg, 1995, 60(6): 1762-1764.
15. 吕小东, 杨克明, 李守军, 等. 阜外医院71例Rastelli手术的近中期结果. 中华胸心血管外科杂志, 2020, 36(1): 5-9.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The operative strategy after palliative shunt for corrected transposition of great artery (cTGA) with left ventricular outflow tract obstruction and cardiac malpostion

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