CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
55
1457: DOUBLE-ROOT SWITCH: TOTAL ANATOMICAL
CORRECTION FOR TRANSPOSITION OF THE GREAT
ARTERIES
Ga¡ucio Furlanetto
1
, Beatriz Furlanetto
1
, Sandra Henriques
1
, Lilian
Lopes
2
, Flavia Pasquinelli
1
, Eduardo Miranda
1
, Elssi Espinosa
1
,
Maria Emilia Pereira
1
, Salvador Cristavao
1
1
Real e Benemarita Associao Portuguesa de Beneficanci, Brazil
2
Pediatric Echocardiography, Real e Benemarita Associao Portuguesa
de Beneficanci, Brazil
Introduction:
Aortic and pulmonary root translocation are alterna-
tive surgical procedures used to correct several congenital defects.
To correct transposition of the great arteries, ventricular septal
defect and pulmonary stenosis (TGA/VSD/PS), we proposed the
double-root translocation with preservation of the pulmonary valve
(DRTPV). We are now proposing the double-root switch (DRS) to
correct transposition of the great arteries (TGA).
Methods:
From March 2006 to September 2011, 10 children with
TGA/CIV/PS were subjected to some kind of translocation root.
Group A: five patients underwent the Nikaidoh procedure, five were
males, three newborn. The reconstruction of the right ventricular
outflow tract was done with a valved conduit. Group B: five patients
underwent the DRTPV procedure, three children were males, one
newborn. Group C consisted of two neonates with simple TGA who
submitted to DRS. The DRS procedure consists of aortic transloca-
tion with the aortic valve and the coronary arteries from the right to
the left ventricle and pulmonary root translocation with the pulmo-
nary valve to the right ventricle.
Results:
In groups A and B there was one death (20%) each. The
remaining children had excellent clinical outcomes in the ICU and
were discharged from hospital in good clinical condition and with
good echocardiographic control. In Group C there were no deaths.
Conclusion:
DTPPV can theoretically be considered a better option
to correct TGA/CIV/PS because it anatomically corrects the RVOT
and LVOT. We also believe that DRS anatomically corrects all the
structures of the heart with TGA, including the aortic valve and aortic
root that are positioned to the LV, and the pulmonary root and the
pulmonary valve that are positioned to the RV.
1465: RESOURCE UTILISATION AND ONE-YEAR
OUTCOMES IN INFANTS WITH SINGLE-VENTRICLE
LESIONS
P Namachivayam
1,2
, J Millar
1
, Y d’Ydekem
2,3,4
W Butt
1,3,4
1
Intensive Care Unit, Royal Children’s Hospital, Melbourne, Australia
2
Department of Cardiac Surgery, Royal Childrens Hospital,
Melbourne, Australia
3
Murdoch Children’s Research Institute, Melbourne, Australia
4
Department of Paediatrics, University of Melbourne, Australia
Background:
Infants with single-ventricle (SV) circulations utilise a
significant proportion of hospital resources. These children account
for the largest group of long-stay patients in ICU at our institution
(20% of patients staying
≥
28 days). We reviewed our resource utili-
sation and one-year outcomes of infants with SV physiology.
Methods:
From 2005 to 2011, 130 infants with SV lesions were
admitted to ICU; 121 received surgical palliation. Data were collect-
ed in this group
.
Results:
One-year survival after stage 1 palliation was 76% (95% CI:
67–83). Median (IQR) ICU length of stay was 11 (7.3–21.6) days; 24
(20%) patients stayed in ICU for
≥
28 days [40 (34–56)]. Mortality
was higher in those who stayed
≥
28 days than those who did not:
12/24 (50%) vs 17/97 (17.5%) (
p
=
0.001). In the first year of life,
SV infants averaged three ICU admissions, utilised 8.7% of ICU
bed days, accounted for 16% of ICU long-stay admissions and had
a stay of 55 (38–83) days in hospital; 38 (31%) received mechani-
cal support. Risk factors for long stay were lower birth weight (OR
0.29/kg, 95% CI: 0.11–0.76), early re-operation after stage 1 (OR
3.7, 95% CI: 1.2–11.4) and ECMO (OR 6.1, 95% CI: 2–18.3). Risk
factors for one-year mortality were smaller ascending aorta diameter
(OR 0.65/mm, 95% CI: 0.42–1), associated cardiac lesion (OR 3.8,
95% CI: 1.1–13.2), and ECLS requirement (one run: OR 22.1, 95%
CI: 6.0–81.4 and two or more runs: OR 59.4, 95% CI: 5–709).
Conclusion:
Mortality associated with SV operations remains
high and these children utilise considerable hospital resources.
Requirement for mechanical support after stage 1 operations is asso-
ciated with a poor outcome: no ECMO: 92% survival; one run of
ECMO: 48% survival; two runs of ECMO:
<
15% survival.
1480: LONG-TERM FUNCTION OF HOMOGRAFTS USED
IN INFANTS FOR RECONSTRUCTION OF THE RIGHT
VENTRICULAR OUTFLOW TRACT
Marc Rebel, Thomas Gentles, Jill Faulkner, Sally Roberts, Kirsten
Finucane
The Green Lane Paediatric and Congenital Cardiac Service at
Starship Children’s Hospital, Auckland, New Zealand
Aim:
Assessment of the outcome of homografts used to reconstruct
the right ventricular outflow tract (RVOT) in infants in a single unit.
Methods:
Between September 1995 and April 2011, 48 consecu-
tive patients under the age of one year were identified from the
departmental surgical database. Mean age at the time of operation
was 111
±
109 days, 51% were female. Diagnoses included tetral-
ogy of Fallot with absent or severely stenosed pulmonary valve (
n
=
16), truncus arteriosus (
n
=
26) and complex pathology (
n
=
9).
These patients received 52 homografts (20 pulmonary, 31 aortic;
seven of the 52 homografts were bicuspidised) for reconstruction of
the RVOT. Homografts were procured and stored locally at the New
Zealand Heart Valve Bank from cadavers or organ donors. They were
treated in antibiotic solution for up to 62 hours (mean 49.2
±
7.7) and
stored for a mean of 7.2 days (
±
4.8) at 4°C (39.2°F) before they were
placed in liquid nitrogen for 0.5 to 62 months (mean 16.7
±
17.1).
The primary endpoint was homograft failure, defined as operative
replacement for stenosis (RV pressure
>
60 mmHg on echocar-
diogram) or severe pulmonary regurgitation with right ventricular
dysfunction. Follow up was complete. No early mortality but three
late, non-homograft-related deaths occurred in the study period.
Kaplan-Meier analysis demonstrated a homograft failure rate of 12%
at one year, 32% at three years, 40% at five years, 60% at eight years
and 80% at 10 years. Significant branch pulmonary artery stenosis
(flow acceleration
>
2 m/s on echocardiogram) was associated with
early homograft failure (
p
=
0.04). Patient age, weight and homograft
type and size were not associated with early failure.
Conclusion:
In New Zealand aortic or pulmonary homografts are
the preferred conduit for RVOT reconstruction in infants and give
excellent durability.
1485: OUTCOMES OF SINGLE-VENTRICLE PALLIATION
IN PATIENTS WITH ARCH OBSTRUCTION
Melissa GY Lee
1
, Christian P Brizard
1
, Ajay J Iyengar
1
, Sandeep S
Rakhra
1
, Igor E Konstantinov
1
, Andreas Pfaumer
2
, Yves d’Udekem
1
1
Department of Cardiac Surgery, The Royal Children’s Hospital,
Department of Paediatrics, University of Melbourne and the Murdoch
Children’s Research Institute, Melbourne, Australia
2
Department of Cardiology, The Royal Children’s Hospital,
Department of Paediatrics, University of Melbourne and the Murdoch
Children’s Research Institute, Melbourne, Australia
Background:
Outcomes of patients undergoing single-ventricle
palliation and arch repair are unknown.
Methods:
The follow up of 70 consecutive patients undergoing
single-ventricle palliation and arch repair, excluding HLHS between
1983 and 2008 were reviewed. Dominant diagnoses were DILV (28),
tricuspid atresia (16), DORV (six), AVSD (seven), mitral stenosis/
atresia (five), TGA hypoplastic RV (three) and other (six). Arch
anomalies were coarctation (48), interrupted arch (10) and arch
hypoplasia (12). A strategy of performing a neonatal stage 1 Damus
procedure with arch repair and shunt became the dominant approach
