Restrictive Left Ventricle-to-Pulmonary Artery Conduit as an Alternative Biventricular Strategy in Complex
Alexander Moiroux-Sahraoui1,2, Neil Derridj2,3, Ségolène Bernheim1,2
1M3C-Paediatric Cardiac Surgery, Hôpital Universitaire Necker Enfants-Malades, AP-HP, 75015 Paris, France.
Objectives:
Biventricular repair of congenitally corrected transposition of the great arteries (ccTGA) with a nonrestrictive ventricular septal defect (VSD) and left ventricular outflow tract obstruction ("complex ccTGA") provides suboptimal long-term results and carry a high risk of surgical atrioventricular block (AVB). We report outcomes of a restrictive left ventricle-to-pulmonary artery (LV-PA) conduit without VSD closure.
Methods:
Retrospective single-centre review (January 1999-January 2024) of complex ccTGA patients receiving a restrictive LV-PA conduit without VSD closure.
Results:
Nine of 553 ccTGA patients met inclusion criteria (median age 5 years, weight 18 kg). Unfavorable anatomy was mainly due to inlet or remote VSD (n = 5) and/or atrioventricular valves straddling (n = 2). Over a median follow-up of 12.5 years, there were no operative or late deaths and no permanent pacing for AVB. Freedom from reintervention was 62.5% at 10 years. At last follow-up, 8 of 9 patients were in NYHA class I-II and median SpO2 was 95%. Tricuspid regurgitation was basent or mild in 8 cases and moderate in 1 case. 2 patients had decreased morphologic right ventricle function and morphologic left ventricular function was preserved in all.
Conclusions:
Restrictive LV-PA conduit placement without VSD closure is a safe biventricular alternative in complex ccTGA unsuitable for anatomic repair or single-ventricle palliation.
