Surgery for the Complex Transposition of the Great Arteries: Bex-Nikaidoh Operation

Vladlen V. Bazylev, Igor E. Chernogrivov, Aleksei E. Chernogrivov

Federal State Center for cardiovascular Surgery, Penza, Russia

Date, time and location: 2018.05.25 15:30, Press Hall, 2F

Abstract

Objective: symptomatic infants with complex transposition of the great arteries and pulmonary outflow obstruction pose significant challenge. Within this cohort, patients can have different tactics. We review our experience with this difficult subset by mean of Bex-Nikaidoh operation.

Methods: A total of 8 consecutive symptomatic infants with TGA, VSD and PS underwent surgical intervention between 2008 and 2017. Of them, 7 patients (87.5%) had one or more previous palliative procedures. Patients' weights ranged from 4.2 to 9.2 kg. All patients had two-ventricle repair by aortic root translocation with replantation of coronary arteries (6/75.0%) or by the technique without coronary arteries detachment (2/25.0%). There were implanted 8 homografts for the pulmonary outflow reconstruction as a part of anatomical repair as well.

Results: overall early mortality was 12.5% (1/8) and for those who were observed at follow-up (M=56 months) the mortality was absent. For the entire cohort there was no need for the reoperation save 1 case (ballooning of the pulmonary branch stenosis and later the open reoperation). The cumulative freedom using the Kaplan-Meier estimates was 80.0%. Also, during the lapse of time the some discrepancy between «oversized» homografts and patient’s weight and body surface area is gradually decreasing. Thus, the median z-score of the implanted homografts immediately after operation was higher compared with follow-up period (8.6±3.4 and 2.6±2.2; p=0.001)

Conclusions: Bex-Nikaidoh operation as a surgical repair of TGA with pulmonary stenosis is feasible although technically challenging. Meanwhile, this type of repair appears durable and provides with good follow-up outcome.