Abstract
Objective. We have reviewed our experience with the double barrel Damus–Kaye–Stansel operation (dbDKS) in patiens with univentricular hearts following pulmonary artery banding (PAB). The main purpose was to investigate the dbDKS efficiency in terms of relieving a subaortic obstruction without complications.
Material and methods. From January 2010 to December 2016, 9 patients with functionally single ventricle and ventriculo-arterial discordance underwent PAB (median age 28 (3–55) days; weight 3.4 (1.9–3.8) kg). Aortic coarctation was simultaneously repaired in 4 cases (44%). All 9 patients subsequently underwent PA debanding, creation of DKS connection at a median age of 15.1 (4.5–40.8) months and weight 9.1 (5.9–13.7) kg and also underwent bidirectional Glenn procedure. Catheterization angiography was performed prior to dbDKS. The relationship of the great arteries was anterior-posterior in all cases. The diameter of bulboventricular foramen measured in the end-systole was 9 (5–17) mm, compared to the aortic valve diameter of 14 (10–19) mm, Z-score 4.27±1.62. One patient (11,1%) had severe subaortic obstruction (3.5 mm). The median follow-up after the dbDKS was 5.3 (2.3–8.5) years. Routine follow-up included echocardiography at 6-monthly intervals. Angiography was repeated prior to Fontan completion.
Results. There were no hospital deaths and no complications related to the dbDKS connection. The median peak systolic single ventricle to aorta gradient was reduced from 22 (10–32) to 6 (4–9) mm Hg after dbDKS (p<0.001). Aortic and pulmonary insufficiency was trivial in all patients. Eight of 9 patients (88.9%) underwent successful Fontan completion at a median age 4.2 (2.8–5.4) years with no early and late deaths. One patient is currently awaiting this completion.
Conclusions. The double barrel Damus–Kaye–Stansel operation is an effective and safe method of relieving subaortic obstruction in univentricular hearts and can be performed with excellent mid-term results.
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About the authors
- Oleg Yu. Kornoukhov, Cand. Med. Sc., Cardiovascular Surgeon, ORCID
- Vladimir N. Il’in, Dr. Med. Sc., Professor, Head of Department, ORCID
