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Published on: July 18, 2014
Long-Term Outcome After the En Bloc Rotation of the Outflow Tracts Including Patients With Congenitally Corrected
Michaela Kreuzer1,2, Eva Sames-Dolzer1,2, Andreas Tulzer2,3
1Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, Linz 4020, Austria.
Insights
The En-bloc rotation for transposition of the great arteries shows promising long-term outcomes. Combining it with the Mustard operation yielded excellent results, even in complex cases.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Repair
- Great Arteries Anomalies
Background:
- Transposition of the great arteries (TGA) with left ventricular outflow tract obstruction requires complex surgical correction.
- The En-bloc rotation technique offers an anatomic repair, but long-term data, especially when combined with the Mustard operation, are limited.
Purpose of the Study:
- To evaluate the long-term outcomes of the En-bloc rotation procedure for TGA with left ventricular outflow tract obstruction.
- To assess the feasibility and results of combining En-bloc rotation with the Mustard operation.
Main Methods:
- Retrospective analysis of 38 patients undergoing En-bloc rotation between 2003 and 2024.
- Inclusion of three patients who had simultaneous Mustard operation for congenitally corrected transposition.
- Data collection on operative times, pulmonary valve preservation, and short- and long-term outcomes.
Main Results:
- The En-bloc rotation was performed in 38 patients with a median follow-up of 9.3 years.
- Hospital mortality was 5% (2 patients); three additional deaths occurred during follow-up.
- Five surgical reinterventions were needed; no adverse events were observed in the three patients who underwent simultaneous Mustard operation.
Conclusions:
- The En-bloc rotation demonstrates very promising long-term outcomes due to its anatomic repair.
- The combined En-bloc rotation and Mustard operation can be performed with excellent short-term results, supported by growing surgical experience.
Objectives:
Despite the increasing use of the en bloc rotation of the outflow tracts to treat patients with transposition of the great arteries with left ventricular outflow tract obstruction, long-term outcome data are scarce. Cases with simultaneous Mustard operation are a challenging technical expansion. This retrospective study aims to evaluate long-term outcomes in a single-centre cohort.
Methods:
All patients undergoing the en bloc rotation at the Children's Heart Center Linz between 2003 and 2024 were retrospectively analysed.
Results:
The en bloc rotation was performed in 38 patients. Median age at operation was 4.1 (0.7; 23.9) months, weight 5.4 (3.7; 9.6) kg. A congenitally corrected transposition was present in 3 patients, in which a simultaneous Mustard procedure was performed. Median cardiopulmonary bypass time was 291 (270; 353) minutes, aortic cross-clamp time 160 (142; 185) minutes. The pulmonary valve could be preserved in 24 children (63%). Two patients died during the hospital stay (5%). During a follow-up period of median 9.3 (4.4; 14.3) years, 3 further children deceased, 5 surgical reinterventions were necessary. There was no death or surgical reintervention in the congenitally corrected transposition group.
Conclusions:
The long-term outcome of the en bloc rotation is very promising, as could be expected due to the anatomic repair with growth potential in all tubular structures. The increased experience also with the Mustard operation allowed the combination of both complex procedures with excellent short-term outcome.
Clinical Registration Number:
EK Nr 1011/2025, Ethics committee of the Medical Faculty at the Johannes Kepler University Linz.
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