Transatrial Right Ventricle Outflow Reconstruction in Patients with Congenital Heart Disease

Anton A. Atmashkin, Vadim P. Didyk, Alex I. Kim, Tigran R. Grigoryants, Alex E. Popov, Maria V. Vlasova

A.N. Bakoulev Scientiffic Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation., Moscov, Russia

Date, time and location: 2018.05.26 08:30, Press Hall, 2F

Abstract

Aim: Examine benefits of transatrial right ventricle outflow reconstruction compared to "classical" reconstruction in infants.

Methods: From June 2014 to October 2017, in the reconstructive surgery department A.N. Bakoulev Scientific Center for Cardiovascular Surgery was made 22 transatrial reconstruction in patients with tetralogy of Fallot and double outlet right ventricle (group №1). The average was 7 months (3 to 13 months). Pulmonary valve Z-Score was -3,38 (-1,5 – -4,8). Right ventricle reconstruction was performed in 18 patients primarily; after BTS – 4 patients. Twenty patients control group operated according classical method from 2012 to 2014 was formed (group №2).

Results: No complications related directly to surgery were noted. In group 1: cardiopulmonary bypass time was 46 min (26-57 min), aortic cross-clamping - 17 min (15-29 min). Echo-data confirmed RV-PA gradient decrease by 40%-60% in 90% of cases. Eight months (3-11 months) after reconstruction 11 patients underwent radical correction. One patient underwent PA branches plastic with an autopericardial patch. The second one has a right atrial diverticle (10 mm). Eight patients were required to excise abnormal fibrous-muscular mass in right ventricle. And only one patient underwent right ventricular outlet plastic by the monocusp xenopericardium patch. In all cases except one, valve is increased satisfactory size. In group 2: cardiopulmonary bypass time was 72 minutes (50-140 minutes), aortic cross-clamp was 39 minutes (26-57 minutes). The patients were extubated in 3 days (1-5 days), IUP was 7 μg / kg / min. Patients were carried out at cardio-department at 4th day (3-5 days). Two patients in the group (10%) had an RVOT aneurysm.

Conclusions: 1. Transatrial RVOT is an alternative method that allows to avoid a number complications associated with ventriculotomy, and associated with shorten rehabilitation period; 2. Carrying out subsequent radical correction in our study did not require transannular valve plastic in most cases.