Implications of incising the ventricular septum in double outlet right ventricle and in the Ross–Konno operation☆

Abstract

Objective Incision into the ventricular septum in complex biventricular repair is controversial, and has been blamed for impairing left ventricular function. This retrospective study evaluates the risk of a ventricular septal incision in patients undergoing double outlet right ventricle (DORV) repair and Ross–Konno procedure. Methods From January 2003 to September 2007, 11 patients with DORV had a ventricular septum (VS) incision and 12 DORV patients did not. Sixteen patients had a Ross–Konno, and 16 had an isolated Ross procedure. The ventricular septal incision was made to match at least the diameter of a normal aortic annulus. In DORV, the VSD was enlarged superiorly and to the left. In the Ross–Konno, the aortic annulus was enlarged towards the septum posteriorly and to the left. Results The median follow-up for the study is 19 months (1 month–4 years). For DORV, there were no significant differences in discharge mortality ( p = 0.22), late mortality ( p = 0.48), or late mortality plus heart transplant ( p = 0.093). Although patients with DORV and VSD enlargement have a more complex postoperative course, there were no differences in ECMO use ( p = 0.093), occurrence of permanent AV block ( p = 0.55), left ventricular ejection fraction (LVEF) ( p = 0.40), or shortening fraction (LVSF) ( p = 0.50). Similarly, for the Ross–Konno there were no significant differences in discharge mortality ( p = 0.30), late mortality ( p = NS), LVEF (p = 0.90) and LVSF ( p = 0.52) compared to the Ross, even though the Ross–Konno patients were significantly younger ( p < 0.0001). Conclusion Making a ventricular septal incision in DORV repair and in the Ross–Konno operation does not increase mortality and does not impair the LV function. The restriction of the VSD remains an important issue in the management of complex DORV. These encouraging results need to be confirmed by larger series.

Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle

“…If the diameter of the VSD is smaller than that of the aortic valve, it is considered restrictive. 47) 48) …”

Biventricular Repair of Double Outlet Right Ventricle: Preoperative Echocardiography and Surgical Outcomes

“…4 The modified Konno-Rastan procedure for subaortic stenosis was a preferred choice to relieve LVOTO after biventricular repair for DORV. 5,6 Augmentation or reconstruction of the RVOT included hypertrophic muscle resection, RV-PA conduit, and transannular patch placement. 7 Results, unless stated otherwise, were expressed as mean (+ standard deviation).…”

Ross procedure in congenital aortic valve disease surgery: graft selection

“…Авторы сде-лали заключение об обнадеживающих функциональных результатах операции и минимальном риске [29]. Анало-гичные данные приводят и другие исследователи [23,26].…”