| Title: |
TGA + IVS + LVOTO: patterns of practice and outcomes |
| Authors: |
Esmaeil, Husain; Jacobs, Jeffrey P.; Tchervenkov, Christo I.; Kansy, Andrzej; Maruszewski, Bohdan; Tobota, Zdzislaw; St. Louis, James D.; Kirklin, James K.; Overman, David M.; Vida, Vladimiro; Herbst, Claudia; Ashfaq, Awais; Al-Halees, Zohair; Sarris, George E. |
| Source: |
Cardiology in the Young ; volume 33, issue 3, page 342-348 ; ISSN 1047-9511 1467-1107 |
| Publisher Information: |
Cambridge University Press (CUP) |
| Publication Year: |
2023 |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1017/s1047951122003924 |
| Availability: |
https://doi.org/10.1017/s1047951122003924; https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1047951122003924 |
| Rights: |
http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.34363 |
| Database: |
BASE |