Stoica S, Kreuzer M, Dorobantu DM, Kostolny M, Nosal M, Hosseinpour AR, Martinez FL,
Generali T, Hasan A, Mair R, Hazekamp M.J Thorac Cardiovasc Surg. 2022 Nov;164(5):1249-1260. doi: 10.1016/j.jtcvs.2022.05.047. Epub 2022 Jul 20.PMID: 36028361
Commentary from Dr. Yasuhiro Kotani (Okayama, Japan), chief section editor of Congenital
Heart Surgery Journal Watch:
Take Home Points:
- Both aortic root translocation and en bloc rotation resulted in excellent long-term survival.
- More right ventricular outflow tract/conduit reintervention was required in aortic root translocation
- Patients with en bloc rotation had more aortic valve regurgitation during the follow-up
Summary
This is a retrospective, multicentric, observational study from European countries, reporting results after the aortic root translocation and en bloc rotation of the outflow tract procedures. A total of 70 patients (62.9% male; median age, 1 year; range 4 days to 12.4 years) were included: n=43 in the aortic root translocation group and N=27 in the en bloc rotation group. Those in the aortic root translocation group were older and more likely to have had previous procedures (P<.0001), but cardiac anatomy was similar in both groups. Aortic root translocation and en bloc rotation early mortality (30 days) was similar (4.7%vs 3.7%, P=0.08). Late survival and freedom from any cardiac reintervention were 92.7% and 16.9% at 15 years overall,
respectively. Freedom from right ventricular outflow tract/conduit reintervention was better in the en bloc rotation group than in the aortic root translocation group (100%vs 24.5%, P=0.0003), but more patients in the en bloc rotation group had moderate (or worse) aortic valve regurgitation during follow-up (16% vs 2.6%, P=0.07).
Comment
This multicenter study included 70 patients, relatively large number of patients, who had repair for complex transposition of the great arteries. The study demonstrated that both aortic root translocation and en bloc rotation are valuable surgical options for the treatment of complex transposition of the great arteries and double outlet right ventricle based on the excellent survival of 92.7% at 15 years. However, greater than 80% of patients required any type of cardiac reintervention. In the en bloc rotation group, there was better freedom from right ventricular outflow tract reinterventions, but a higher probability of aortic valve regurgitation. This is reasonable as native pulmonaly valve was kept in 67% in patients having en bloc rotation, while RV-PA conduit was used in 58% of patients with aortic root translocation. In terms of aortic valve regurgitation, the authors mentioned that oversizing the VSD patch in patients with early experience of en bloc rotation is the reason which were overcome recently. Another possible reason for aortic valve regurgitation may be distortion of sinus valsalva after coronary reimplantation but no evidence. It may be difficult to conclude which procedure is better compared to another as patients with this disease have a wide variety of anatomies, including pulmonary valve size and coronary pattern. Therefore, surgical choice should be made based on each patient’s anatomy.
