The following is the summary of “Aortic root translocation and en bloc rotation of the outflow tracts surgery for complex forms of transposition of the great arteries and double outlet right ventricle: A multicenter study” published in the November 2022 issue of Thoracic and Cardiovascular Surgery by Stoica, et al.
Complex transposition of the great arteries with a double outlet right ventricle that cannot be repaired with Rastelli-type surgery has multiple treatment options, but only limited data on long-term outcomes are available. To describe outcomes following aortic root translocation and en bloc rotation of the outflow tract procedures is the primary objective of this study. Observational, multi-center study with a retrospective design. There was a comprehensive collection of clinical, anatomical, procedural, and follow-up data (median, 4.43 years).
There were a total of 70 patients (62.9%) involved; (n=43) in the aortic root translocation group and (n=27) in the en bloc rotation group. The cardiac anatomy was comparable between the 2 groups, although those who underwent aortic root translocation were older (P=.01) and more likely to have undergone previous procedures (P<.0001). Short-term mortality following aortic root translocation and en bloc rotation were comparable at 30 days (4.7% vs 3.7%, P=.8). At 15 years, the overall survival rate was 92.7%, and the percentage of people who did not require any further cardiac intervention was 16.9%.
More patients with severe or worse aortic valve regurgitation developed in the en bloc rotation group compared to the aortic root translocation group during follow-up (16% vs. 2.6%, P=.07), but neither group required reintervention on the right ventricular outflow tract or conduit. In cases of complex transposition of the major arteries with a double outlet right ventricle, both aortic root translocation and en bloc rotation are useful surgical choices. The risk of aortic regurgitation was higher in the en bloc rotation group, but they had a lower rate of repeat operations for the right ventricular outflow tract. More research on these methods is needed to identify the primary drivers of these disparities.