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DOI: 10.1055/s-0031-1297645
Réparation à l'Etage Ventriculaire (REV-procedure) – Our choice of treatment for patients with TGA, VSD and LVOTO
Introduction: TGA with VSD and LVOTO precludes an arterial switch operation. Options are Rastelli, Nikaidoh or REV procedure. We present our experience and operative technique of the REV procedure in patients with TGA, VSD and LVOTO.
Aims: We present three cases with TGA, VSD and LVOTO, corrected by the REV procedure. Patients age was 166±62 days, weight was 6.8±1.5kg, two patients received an aortopulmonary shunt before repair. Our surgical technique implies transsection and shortening of the aorta on CPB in moderate hypothermia with cardioplegic arrest. The pulmonary artery is brought in front of the aorta (Lecompte-Maneuver), after direct closure of the pulmonary valve. Before reconnecting the aorta, the VSD is enlarged by partial resection of the conal septum. We consider VSD enlargement as part of the routine procedure, thus reducing the incidence of late LVOTO. VSD-closure is performed transventricular and transatrial by creating an intraventricular tunnel to reroute the blood from the left ventricle to the aorta. The bifurcation is connected directly to the RVOT with a non-obstructive pericardial hood. Recovery of all patients was uneventful.
Conclusion: REV procedure is much less complex than Nikaidoh operation, therefore early and long-term morbidity and mortality should be lower. The Rastelli operation implies implantation of a valved conduit with the consequence of multiple conduit-replacements in later life. Planning a REV procedure means that surgery can be delayed, which reduces morbidity associated with CPB in the newborn. In some cases, AP-shunt might be necessary prior to correction. Early or mid-term reoperations are less likely than after implantation of a valved conduit. Therefore REV procedure is our choice of treatment for patients with TGA, VSD and LVOTO.