초록접수 현황
| 15F-139 | 구연 발표 |
Early Outcomes of Aortic Root Translocation in TGA or DORV
Jeong-Jun Park¹, Won Kyoun Park¹, Ji Hyun Bang¹, Chun Soo Park¹, Tae-Jin Yun¹, Jae Suk Baek², Jeong Jin Yu², Young-Hwue Kim², Jae-Kon Ko², Hyun Woo Goo³
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea¹, Department of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea², Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea³
Background : Aortic root translocation is a challenging surgical option for repair of transposition of the great arteries or double outlet right ventricle with ventricular septal defect, and pulmonary stenosis. Comparing with traditional procedures of Rastelli or REV, this operation can provide an normal alignment of left ventricular outflow tract. We reviewed our experience with this technique and analyzed the early outcomes.
Methods : Eight patients with TGA(n=4) or DORV(n=4, hypoplastic RV in 1), VSD and PS have been treated by aortic root translocation since February 2009. In all patients, RVOT was reconstructed with an anterior pericardial patch transannulally. In last three patients, coronary artery in situ after extensive mobilization was applied instead of harvesting. Patient age ranged between 5.1 and 20.4 months. The median age was 9.2months. Weight ranged between 6.4 and 12.0Kg. Palliative procedures prior to the definite repair were balloon atrial septostomy in 5 and BT shunt in 6. Median cardiopulmonary bypass and aortic cross-clamp times were 281.5 (235 - 409) minutes and 148 (94-196) minutes respectively. Concomitant procedures were bidirectional cavo-pulmonary shunt in 1 and resection of accessory mitral valve tissue in 1. Median ICU and postoperative stay were 5 and 14.5 days each.
Results : Postoperative complications included bleeding control (n=2), delayed sternal closure (n=4) and chylothorax (n=1). No patients developed LVOTO and RVOTO during a median follow-up of 10.2months. At last echocardiogram, Grade I AR was present in 2 and all other patients showed less than trivial AR, but most of pateints showed free pulmonary regurgitation. Surgical intervention was necessary for residual VSD closure and permanent pacemaker implantation due to 2:1 AV block in a same patient. There were no early deaths and 2 late deaths (7.7 and 9.0 months). One late death was caused by left main coronary artery insufficiency due to compression of LPA placed downward.
Conclusion : Aortic root translocation is a valuable procedure for patients with TGA or DORV with VSD and PS. The reoperation rate for LVOTO can be kept low, but the use of transannular patch in RVOT requires a close follow-up of pulmonary regurgitaion.
Methods : Eight patients with TGA(n=4) or DORV(n=4, hypoplastic RV in 1), VSD and PS have been treated by aortic root translocation since February 2009. In all patients, RVOT was reconstructed with an anterior pericardial patch transannulally. In last three patients, coronary artery in situ after extensive mobilization was applied instead of harvesting. Patient age ranged between 5.1 and 20.4 months. The median age was 9.2months. Weight ranged between 6.4 and 12.0Kg. Palliative procedures prior to the definite repair were balloon atrial septostomy in 5 and BT shunt in 6. Median cardiopulmonary bypass and aortic cross-clamp times were 281.5 (235 - 409) minutes and 148 (94-196) minutes respectively. Concomitant procedures were bidirectional cavo-pulmonary shunt in 1 and resection of accessory mitral valve tissue in 1. Median ICU and postoperative stay were 5 and 14.5 days each.
Results : Postoperative complications included bleeding control (n=2), delayed sternal closure (n=4) and chylothorax (n=1). No patients developed LVOTO and RVOTO during a median follow-up of 10.2months. At last echocardiogram, Grade I AR was present in 2 and all other patients showed less than trivial AR, but most of pateints showed free pulmonary regurgitation. Surgical intervention was necessary for residual VSD closure and permanent pacemaker implantation due to 2:1 AV block in a same patient. There were no early deaths and 2 late deaths (7.7 and 9.0 months). One late death was caused by left main coronary artery insufficiency due to compression of LPA placed downward.
Conclusion : Aortic root translocation is a valuable procedure for patients with TGA or DORV with VSD and PS. The reoperation rate for LVOTO can be kept low, but the use of transannular patch in RVOT requires a close follow-up of pulmonary regurgitaion.
책임저자: Jeong-Jun Park
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
연락처 : Jeong-Jun Park, Tel: 02-3010-3587 , E-mail : pkjj@amc.seoul.kr
