Biventricular repair of double-outlet right ventricle with noncommitted ventricular septal defect using intraventricular conduit

J Thorac Cardiovasc Surg. 2020 Jun;159(6):2397-2403. doi: 10.1016/j.jtcvs.2019.07.084. Epub 2019 Aug 24.

Abstract

Objective: Biventricular repair of double-outlet right ventricle with noncommitted ventricular septal defect is preferred, but previously developed surgical procedures are complicated and associated with high mortality and morbidity. We developed a technique using an intraventricular conduit to connect the ventricular septal defect and the aorta in this anomaly in patients aged more than 2 years.

Methods: Thirty-one patients (age 2-23 years; median, 5.4) with double-outlet right ventricle with noncommitted ventricular septal defect underwent biventricular repair with intraventricular conduit. A 16-mm or 19-mm polytetrafluoroethylene (Gore-Tex; WL Gore & Associates, Flagstaff, Ariz) vascular prosthesis was used to construct the intraventricular conduit rerouting the ventricular septal defect to the aorta, with enlargement of the ventricular septal defect and resecting the hypertrophic muscular bands in the bilateral conus when necessary. Follow-up was made in all patients with a median duration of 93 months (range, 8-140 months).

Results: One patient died during hospitalization and 1 patient died at 8 months after operation, making the mortality 6.5%. The peak pressure gradient across the left ventricular outflow tract was less than 30 mm Hg in all patients but 1 (3.3%). In the last patient, it increased from 16 mm Hg early after operation to 50 mm Hg at 7 years follow-up. The peak pressure gradient across the right ventricular outflow tract ranged from 6 to 30 mm Hg in all patients. One patient had moderate mitral regurgitation with New York Heart Association class II. One patient had preoperative severe pulmonary arterial hypertension (mean pressure, 50 mm Hg) and was treated with bosentan. Other patients were in New York Heart Association class I.

Conclusions: Biventricular repair with intraventricular conduit is a relatively simple and safe procedure for patients aged more than 2 years with double-outlet right ventricle with noncommitted ventricular septal defect, with excellent early and midterm outcomes.

Keywords: biventricular repair; double-outlet right ventricle; intraventricular conduit; noncommitted ventricular septal defect.

Publication types

  • Research Support, Non-U.S. Gov't
  • Video-Audio Media

MeSH terms

  • Adolescent
  • Aorta / abnormalities
  • Aorta / diagnostic imaging
  • Aorta / physiopathology
  • Aorta / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis Implantation / mortality
  • Blood Vessel Prosthesis*
  • Cardiac Surgical Procedures / adverse effects
  • Cardiac Surgical Procedures / instrumentation*
  • Cardiac Surgical Procedures / mortality
  • Child
  • Child, Preschool
  • Double Outlet Right Ventricle / diagnostic imaging
  • Double Outlet Right Ventricle / mortality
  • Double Outlet Right Ventricle / physiopathology
  • Double Outlet Right Ventricle / surgery*
  • Female
  • Heart Septal Defects, Ventricular / diagnostic imaging
  • Heart Septal Defects, Ventricular / mortality
  • Heart Septal Defects, Ventricular / physiopathology
  • Heart Septal Defects, Ventricular / surgery*
  • Heart Ventricles / abnormalities
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology
  • Heart Ventricles / surgery*
  • Hemodynamics*
  • Hospital Mortality
  • Humans
  • Male
  • Prosthesis Design
  • Recovery of Function
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Ventricular Function*
  • Young Adult