Modified Nikaidoh procedure for the correction of complex forms of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction: mid-term results

摘要

So far, there is no consensus about the optimal surgical management of complex forms of transposition of the great arteries (TGA) with left ventricular outflow tract obstruction (LVOTO) and ventricular septal defect (VSD). Various techniques have been applied to the repair of this lesion type, notably the Rastelli procedure, the reparation a I'etage ventriculaire (REV) and the aortic translocation (Bex/Nikaidoh) procedure. Introduced in 1969, the Rastelli operation has become the standard procedure for the surgical repair of complex forms of TGA [1]. It can be performed with good early results and low early mortality; however, mid- and long-term results have been shown to be unsatisfactory [2-4]. Some authors report the probability of survival without reoperation to be as low as 40% only 5 years after the Rastelli operation [5]. High rates of reinterventions and reoperations due to degeneration of the conduit with right ventricular outflow tract obstruction (RVOTO) and to a lesser extent also due to reobstruction of the left ventricular outflow tract (LVOT) have been found. Most importantly, a high incidence of late deaths has been reported in several studies and 20-year survival excluding early mortality was found to be ~60% [2-4]. The REV technique, introduced in 1982 by Lecompte et a/., was shown to reduce the risk of right ventricular outflow tract (RVOT) and LVOT reobstruction, resulting in lower reoperation rates [5,6]. Moreover, the late mortality is substantially lower.