Current risks and protocols for operations for double-outlet right ventricle. Derivation from an 18 year experience

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Cardiovascular Surgery

Background:

• Double-outlet right ventricle (DORV) is a complex congenital heart defect with historically poor survival rates.
• Previous surgical approaches for DORV repair yielded variable and often suboptimal outcomes.

Purpose of the Study:

• To evaluate the long-term efficacy and survival rates of various surgical repair strategies for different types of DORV.
• To identify optimal treatment protocols based on surgical outcomes and patient characteristics.

Main Methods:

• Retrospective analysis of 127 patients undergoing DORV repair between 1967 and 1984.
• Multivariate analysis and contingency tables to assess survival rates associated with specific repair techniques.
• Categorization of DORV based on ventricular septal defect (VSD) location and surgical approach.

Main Results:

• Intraventricular tunnel repair for DORV with subaortic VSD shows a 99% early survival and 97% 10-year survival in infants.
• Doubly committed VSD repair had similar results, with a notable incidence of late subaortic stenosis.
• Repairs for subpulmonary VSD and noncommitted VSD demonstrated poorer outcomes, highlighting the need for tailored surgical strategies.

Conclusions:

• Intraventricular tunnel repair represents a highly effective strategy for DORV with subaortic VSD, offering excellent functional results and low reoperation rates.
• Surgical outcomes for DORV vary significantly based on VSD type and repair technique, necessitating individualized treatment protocols.
• Further research into optimizing surgical management for complex DORV subtypes is warranted to improve long-term patient survival and quality of life.