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Transposition of the Great Arteries with VSD and LVOTO. The Autograft Procedure for RVOT (the “DREAM”)

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Surgery of Conotruncal Anomalies

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Abstract

In transposition of the great arteries, ventricular septal defect and LVOTO (pulmonary stenosis or atresia), the classical procedures described (Rastelli and REV) can lead to late complications like LV outflow tract obstruction and even more RV outflow tract obstruction leading to reoperations (almost 100 % in Rastelli, 33 % in REV).

This chapter deals with a surgical procedure we have developped combining features of both procedures and using the concept of autograft to decrease the rate of reoperations in the RV outflow.

We perform an intracardiac procedure as in REV, with resection of conal septum, to avoid LV outflow obstruction and the main feature is to use a cylinder of autologous aorta to extend the main PA, located like a Rastelli conduit, avoiding all Lecompte manoeuvers with anterior transfer of pulmonary bifurcation.

Thus the RV outflow and the autograft conduit sutures are free from tension and possible compression, and being an autologous living tissue, the conduit is susceptible to grow. Due to the growth of this autograft, early primary correction is allowed even under 1 year of age.

In our series reported here, half of the patients had a primary procedure without preliminary shunt, and there was an actuarial freedom from RV outflow reoperation of 95 % at 16 years and more.

DREAM is an acronym for: Direct REpair with an Autograft from Marseille

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Authors and Affiliations

  1. Department of Cardio-Thoracic Surgery, Children’s Hospital La Timone, University Marseille-Aix, Marseille, France

    Dominique Metras MD

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  1. Dominique Metras MD
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Correspondence to Dominique Metras MD .

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Editors and Affiliations

  1. Royal Brompton Hospital, London, United Kingdom

    Francois Lacour-Gayet

  2. C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA

    Edward L. Bove

  3. German Pediatric Heart Center, Asklepios Klinik Sankt Augustin Gmb, Sankt Augustin, Germany

    Viktor Hraška

  4. University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA

    Victor O. Morell

  5. Department of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Thomas L. Spray

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Metras, D. (2016). Transposition of the Great Arteries with VSD and LVOTO. The Autograft Procedure for RVOT (the “DREAM”). In: Lacour-Gayet, F., Bove, E., Hraška, V., Morell, V., Spray, T. (eds) Surgery of Conotruncal Anomalies. Springer, Cham. https://doi.org/10.1007/978-3-319-23057-3_19

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  • DOI: https://doi.org/10.1007/978-3-319-23057-3_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23056-6

  • Online ISBN: 978-3-319-23057-3

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