Abstract
Aim of the study: represent early and long-term results of systemic atrioventricular (AV) valve replacement in patients with congenitally corrected transposition of great arteries (CCTGA).
Material and methods. Study data obtained from 56 CCTGA patients with systemic AV-valve insufficiency, Ist group – 45 patients who had systemic atrioventricular valve replacement for CCTGA, and 2nd group included 11 non-operated CCTGA patients. There was a significant difference (p = 0.001) in AV-valve Z-score value (2.0 ± 1.0 and 1.5 ± 0.4). 8 patients in the 1st grope had concomitant pulmonary stenosis All surgery was performed on cardio-pulmonary bypass with moderate hypothermia and cardioplegia. Mechanical prostheses were implanted in all cases, mean diameter was 27.4 ± 2.4 (21–31) mm. Venous AV-valve reconstruction was performed in 6 (13.3%) cases, venous AV-valve replacement – in 4 (8.8%) patients. In patients with venous ventricle outflow obstruction xenopericardial valved conduit had being used.
Results. Early mortality was 11,1%. Bypass time more than 230 minutes and surgery earlier than 2007 were the factors related to early mortality (р = 0.002). Peak diastolic gradient at discharge was 9,8 ± 4,1 mm Hg, mean – 4,9 ±1,8 mm Hg. Systemic valve Z-score more than 1.5 and AV-valve insufficiency were an independent risk factors of non-lethal complication development (р=0.001). Follow-up time was 10.0 ± 1.6 (1–14) years. In the 1st grope follow-up was complete 22 patients (62,0%; 9% mortality) and in 9 patients of the 2nd group (81%; 66% mortality). There was an increase of the peak gradient over time (p=0.01). Three patients required reoperation (valve overgrowth in two cases and bioprosthesis degeneration in one).
Conclusion. Nowadays, valve replacement is the most optimal method of surgical treatment of systemic AV-valve insufficiency of in patients with CCTGA. Natural history of this congenital heart disease is accompanied by low survival rate due to the progression of heart failure, while early detection and time-appropriate surgery achieves good immediate results and acceptable survival rates in the long-term follow-up.
References
- Jonas R.A. Comprehensive surgical management of congenital heart disease: CRC Press Taylor & Francis Group; 2014.
- Podzolkov V.P., Hassan Ali, Vaulina T.N. Atrioventricular discordance: choice of surgical tactics. Russian Journal of Thoracic and Cardiovascular Surgery. 1999; 6: 30–6 (in Russ.).
- Rutledge J.M., Nihill M.R., Fraser C.D., O’Brien Smith E., McMahon C.J., Bezold L.I. Outcome of 121 patients with congenitally corrected transposition of the great arteries. Pediatr. Cardiol. 2002; 23: 137–45. DOI: 10.1007/s00246-001-0037-8
- Graham T.P., Bernard Y.D., Mellen B.G., Celermajer D., Baumgartner H., Cetta F. et al. Long-term outcome in congenitally corrected transposition of the great arteries: a multiinstitutional study. J. Am. Coll. Cardiol. 2000; 36 (1): 255–61. DOI: 10.1016/s0735-1097(00)00682-3
- Prieto L.R., Hordof A.J., Secic M., Rosenbaum R.S., Gersomy W.M. Progressive tricuspid valve disease in patients with congenitally corrected transposition of the great arteries. Circulation. 1998; 98 (10): 997–1005. DOI: 10.1161/01.cir.98.10.997
- Scherptong R.W., Vliegen H.W., Winter M.M., Holman E.R., Mulder B.J., van der Wall E.E. et al. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle: repair or replace. Circulation. 2009; 119 (11): 1467–72. DOI: 10.1161/CIRCULATIONAHA.108.805135
- Podzolkov V.P., Samsonov V.B., Mataev V.S., Danilov T.Yu., Nezhlukto A.A., Gadzhieva A.Sh. Experience in prosthetic systemic atrioventricular valve in patients with corrected transposition great vessels. Russian Journal of Thoracic and Cardiovascular Surgery. 2018; 60 (2): 124–8 (in Russ.). DOI: 10.24022/0236-2791-2018-60-2-124-128
- Filippov A.A, del Nido P.J, Vasilyev N.V. Management of systemic right ventricular failure in patients with congenitally corrected transposition of the great arteries. Circulation. 2016; 134 (17): 1293–302. DOI: 10.1161/CIRCULATIONAHA.116.022106
- Hrasˇka V., Murín P. Surgical management of congenital heart disease I. Springer-Verlag Berlin Heidelberg; 2012.
- Podzolkov V.P., Kokshenev I.V., Danilov T.Yu., Samsonov V.B. Left atrial approach systemic atrioventricular valve replacement in patients with congenital corrected transposition of the great arteries and dextrocardia. 2015; 16 (6): 49–52. (in Russ.).
- Said S.M., Burkhart H.M., Schaff H.V., Dearani J.A. Congenitally corrected transposition of great arteries. World J. Pediatr. Congenit. Heart. Surg. 2011; 2 (1): 64–79. DOI: 10.1177/2150135110386977
- Huhta J. The natural history of congenitally corrected transposition of the great arteries. World J. Pediatr. Congenit. Heart Surg. 2011; 2 (1): 59–63. DOI: 10.1177/2150135110387620
- Hrasˇka V., Duncan B.W., Mayer J.E., Freed M., del Nido P.J., Jonas R.A. Long-term outcome of surgically treated patients with corrected transposition of the great arteries. J. Thorac. Cardiovasc. Surg. 2005; 129 (1): 182–91. DOI: 10.1016/j.jtcvs.2004.02.046
- Talwar S., Ahmed T., Saxena A., Kothari S.S., Juneja R., Airan B. Morphology, surgical techniques, and outcomes in patients above 15 years undergoing surgery for congenitally corrected transposition of great arteries. World J. Pediatr. Congenit. Heart Surg. 2013; 4 (3): 271–7. DOI: 10.1177/2150135113476717
About the authors
- Vladimir P. Podzolkov, Dr. Med. Sc., Professor, Academician of Russian Academy of Sciences, Head of Department, ORCID
- Viktor B. Samsonov, Dr. Med. Sc., Leading Researcher, ORCID
- Viktor S. Mataev, Cand. Med. Sc., Researcher, ORCID
- Sarmat G. Khasiev, Postgraduate, ORCID
- Timur Yu. Danilov, Dr. Med. Sc., Leading Researcher, ORCID
- Ol’ga I. Medvedeva, Dr. Med. Sc., Deputy Head of Department, ORCID
- Mariya Yu. Khal’vani, Cardiovascular Surgeon, ORCID
- Anna A. Nezhlukto, Cand. Med. Sc., Senior Researcher, ORCID
- Vera I. Dontsova, Cand. Med. Sc., Ultrasonic Diagnostics Physician, ORCID
