Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study

Serban Stoica; Michaela Kreuzer; Dan-Mihai Dorobantu; Martin Kostolny; Matej Nosal; Amir-Reza Hosseinpour; Fernando Laviana Martinez; Tommaso Generali; Asif Hasan; Rudolf Mair; Mark Hazekamp

doi:10.1016/j.jtcvs.2022.05.047

Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study

Serban Stoica^*, Michaela Kreuzer, Dan-Mihai Dorobantu, Martin Kostolny, Matej Nosal, Amir-Reza Hosseinpour, Fernando Laviana Martinez, Tommaso Generali, Asif Hasan, Rudolf Mair, Mark Hazekamp

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

14 Citations (Scopus)

Abstract

Objective

There are several choices for the correction of complex transposition of the great arteries and double outlet right ventricle not amenable to the Rastelli-type surgery, but outcome data are limited to small series. This study aims to report results after the aortic root translocation and en bloc rotation of the outflow tract procedures.

Methods

This is a retrospective, multicentric, observational study. Clinical, anatomy, procedural, and detailed follow-up data (median, 4.43 years) were collected.

Results

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 (P = .01) 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 = .8). 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 = .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 = .07).

Conclusions

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. In the en bloc rotation group, there was better freedom from right ventricular outflow tract reinterventions, but a higher probability of aortic valve regurgitation. Identifying the main driving forces for these observed differences requires further study of these procedures.

Original language	English
Pages (from-to)	1249-1260
Number of pages	12
Journal	The Journal of thoracic and cardiovascular surgery
Volume	164
Issue number	5
Early online date	19 Jul 2022
DOIs	https://doi.org/10.1016/j.jtcvs.2022.05.047
Publication status	Published - 1 Nov 2022

Bibliographical note

Publisher Copyright:
© 2022 The Authors. Published by Elsevier Inc. All rights reserved.

Keywords

Aorta/surgery
Aortic Valve Insufficiency
Double Outlet Right Ventricle/surgery
Female
Heart Septal Defects, Ventricular/surgery
Humans
Infant
Male
Retrospective Studies
Rotation
Transposition of Great Vessels/surgery
Treatment Outcome

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Stoica, S., Kreuzer, M., Dorobantu, D.-M., Kostolny, M., Nosal, M., Hosseinpour, A.-R., Martinez, F. L., Generali, T., Hasan, A., Mair, R., & Hazekamp, M. (2022). Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study. The Journal of thoracic and cardiovascular surgery, 164(5), 1249-1260. https://doi.org/10.1016/j.jtcvs.2022.05.047

@article{9407930d846945e18ad1ec51db9679bf,

title = "Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study",

abstract = "ObjectiveThere are several choices for the correction of complex transposition of the great arteries and double outlet right ventricle not amenable to the Rastelli-type surgery, but outcome data are limited to small series. This study aims to report results after the aortic root translocation and en bloc rotation of the outflow tract procedures. MethodsThis is a retrospective, multicentric, observational study. Clinical, anatomy, procedural, and detailed follow-up data (median, 4.43 years) were collected. ResultsA 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 (P = .01) 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 = .8). 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 = .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 = .07). ConclusionsBoth 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. In the en bloc rotation group, there was better freedom from right ventricular outflow tract reinterventions, but a higher probability of aortic valve regurgitation. Identifying the main driving forces for these observed differences requires further study of these procedures.",

keywords = "Aorta/surgery, Aortic Valve Insufficiency, Double Outlet Right Ventricle/surgery, Female, Heart Septal Defects, Ventricular/surgery, Humans, Infant, Male, Retrospective Studies, Rotation, Transposition of Great Vessels/surgery, Treatment Outcome",

author = "Serban Stoica and Michaela Kreuzer and Dan-Mihai Dorobantu and Martin Kostolny and Matej Nosal and Amir-Reza Hosseinpour and Martinez, \{Fernando Laviana\} and Tommaso Generali and Asif Hasan and Rudolf Mair and Mark Hazekamp",

year = "2022",

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doi = "10.1016/j.jtcvs.2022.05.047",

language = "English",

volume = "164",

pages = "1249--1260",

journal = "The Journal of thoracic and cardiovascular surgery",

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Stoica, S, Kreuzer, M, Dorobantu, D-M, Kostolny, M, Nosal, M, Hosseinpour, A-R, Martinez, FL, Generali, T, Hasan, A, Mair, R & Hazekamp, M 2022, 'Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study', The Journal of thoracic and cardiovascular surgery, vol. 164, no. 5, pp. 1249-1260. https://doi.org/10.1016/j.jtcvs.2022.05.047

Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study. / Stoica, Serban; Kreuzer, Michaela; Dorobantu, Dan-Mihai et al.
In: The Journal of thoracic and cardiovascular surgery, Vol. 164, No. 5, 01.11.2022, p. 1249-1260.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle

T2 - A multicenter study

AU - Stoica, Serban

AU - Kreuzer, Michaela

AU - Dorobantu, Dan-Mihai

AU - Kostolny, Martin

AU - Nosal, Matej

AU - Hosseinpour, Amir-Reza

AU - Martinez, Fernando Laviana

AU - Generali, Tommaso

AU - Hasan, Asif

AU - Mair, Rudolf

AU - Hazekamp, Mark

PY - 2022/11/1

Y1 - 2022/11/1

N2 - ObjectiveThere are several choices for the correction of complex transposition of the great arteries and double outlet right ventricle not amenable to the Rastelli-type surgery, but outcome data are limited to small series. This study aims to report results after the aortic root translocation and en bloc rotation of the outflow tract procedures. MethodsThis is a retrospective, multicentric, observational study. Clinical, anatomy, procedural, and detailed follow-up data (median, 4.43 years) were collected. ResultsA 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 (P = .01) 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 = .8). 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 = .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 = .07). ConclusionsBoth 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. In the en bloc rotation group, there was better freedom from right ventricular outflow tract reinterventions, but a higher probability of aortic valve regurgitation. Identifying the main driving forces for these observed differences requires further study of these procedures.

AB - ObjectiveThere are several choices for the correction of complex transposition of the great arteries and double outlet right ventricle not amenable to the Rastelli-type surgery, but outcome data are limited to small series. This study aims to report results after the aortic root translocation and en bloc rotation of the outflow tract procedures. MethodsThis is a retrospective, multicentric, observational study. Clinical, anatomy, procedural, and detailed follow-up data (median, 4.43 years) were collected. ResultsA 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 (P = .01) 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 = .8). 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 = .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 = .07). ConclusionsBoth 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. In the en bloc rotation group, there was better freedom from right ventricular outflow tract reinterventions, but a higher probability of aortic valve regurgitation. Identifying the main driving forces for these observed differences requires further study of these procedures.

KW - Aorta/surgery

KW - Aortic Valve Insufficiency

KW - Double Outlet Right Ventricle/surgery

KW - Female

KW - Heart Septal Defects, Ventricular/surgery

KW - Humans

KW - Infant

KW - Male

KW - Retrospective Studies

KW - Rotation

KW - Transposition of Great Vessels/surgery

KW - Treatment Outcome

U2 - 10.1016/j.jtcvs.2022.05.047

DO - 10.1016/j.jtcvs.2022.05.047

M3 - Article (Academic Journal)

C2 - 36028361

SN - 0022-5223

VL - 164

SP - 1249

EP - 1260

JO - The Journal of thoracic and cardiovascular surgery

JF - The Journal of thoracic and cardiovascular surgery

IS - 5

ER -

Stoica S, Kreuzer M, Dorobantu DM, Kostolny M, Nosal M, Hosseinpour AR et al. Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study. The Journal of thoracic and cardiovascular surgery. 2022 Nov 1;164(5):1249-1260. Epub 2022 Jul 19. doi: 10.1016/j.jtcvs.2022.05.047

Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study

Abstract

Bibliographical note

Keywords

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