Kramer Peter, Ovroutski Stanislav, Hetzer Roland, Hübler Michael, Berger Felix
Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
Eur J Cardiothorac Surg. 2014 May;45(5):928-34. doi: 10.1093/ejcts/ezt508. Epub 2013 Nov 4.
Different surgical techniques for the treatment of complex transposition of the great arteries (TGA) with ventricular septal defect and left ventricular outflow tract obstruction (LVOTO) have been developed, in particular the Rastelli operation, the réparation à l'étage ventriculaire procedure and the Nikaidoh procedure. The hitherto published results of the Nikaidoh procedure and its modifications compare favourably with those of other techniques; however, experience with the Nikaidoh procedure is still limited. Here, we report our institutions' early and mid-term results with modifications of the Nikaidoh procedure.
Twenty-one patients who underwent a modified Nikaidoh procedure between 2006 and 2012 at our institution, either as aortic root translocation (n = 17) or as en bloc rotation of the arterial trunk (n = 4), were studied retrospectively.
There were 2 early and 1 mid-term deaths. The follow-up continued for a median of 2.3 years (range 0.3-6.4 years). During the follow-up, the performance of the reconstructed left ventricular outflow tract (LVOT) remained excellent: no reobstruction and no aortic valve regurgitation classified as more than mild were observed. Left ventricular function was well preserved. In 4 patients, a significant reoccurring right ventricular outflow tract obstruction due to conduit failure was observed; so far, two reoperations with conduit replacement have been necessary. The mean right ventricular outflow tract peak gradient was 24 ± 7.2 mmHg at the last follow-up in the remaining patients. No reobstruction of the right ventricular outflow tract occurred in patients with preserved pulmonary valve tissue after en bloc rotation.
The aortic translocation procedure is a valuable surgical option for patients with complex (TGA) with ventricular septal defect and LVOTO. The mid-term results document excellent performance of the reconstructed LVOT. Modifications of the Nikaidoh procedure that preserve pulmonary valve tissue may further reduce the need for right ventricular outflow tract reoperation.
已开发出不同的外科技术用于治疗合并室间隔缺损及左心室流出道梗阻（LVOTO）的复杂大动脉转位（TGA），尤其是Rastelli手术、心室水平修复手术及Nikaidoh手术。迄今已发表的Nikaidoh手术及其改良术式的结果与其他技术相比具有优势；然而，Nikaidoh手术的经验仍然有限。在此，我们报告我们机构对Nikaidoh手术进行改良后的早期及中期结果。
对2006年至2012年期间在我们机构接受改良Nikaidoh手术的21例患者进行回顾性研究，其中17例采用主动脉根部移位术，4例采用动脉干整体旋转术。
有2例早期死亡和1例中期死亡。随访时间中位数为2.3年（范围0.3 - 6.4年）。在随访期间，重建的左心室流出道（LVOT）功能保持良好：未观察到再梗阻，也未观察到大于轻度的主动脉瓣反流。左心室功能得到良好保留。4例患者因管道故障出现明显的复发性右心室流出道梗阻；到目前为止，已进行了两次管道置换再手术。其余患者在最后一次随访时右心室流出道平均峰值梯度为24±7.2 mmHg。动脉干整体旋转后保留肺动脉瓣组织的患者未出现右心室流出道再梗阻。
主动脉移位术是治疗合并室间隔缺损及LVOTO的复杂TGA患者的一种有价值的手术选择。中期结果表明重建的LVOT功能良好。保留肺动脉瓣组织的Nikaidoh手术改良术式可能会进一步减少右心室流出道再次手术的需求。
