Changing results and concepts in the surgical treatment of double-outlet right ventricle: Analysis of 137 operations in 126 patients

Academic Article

Abstract

  • One hundred thirty-seven operations (98 repairs and 39 preliminary or palliative operations) were performed for double-outlet right ventricle (DORV) with concordant atrioventricular connection from January 1967 through July 1982, with 36 hospital deaths (26%). Sixteen (12% of the total of 137 operations) of the nonrepair operations were palliative for uncorrectable malformations. "Classic" DORV was palliated rather than repaired only when there was severe left ventricular or mitral hypoplasia or both (n = 4). Incremental risk factors for hospital death after repair of this subset for the entire period (n = 42) included young age at operation, type of repair and the era. In the current era (1978 through July 1982), 1 death (5%; 70% confidence limits 0.7 to 17%) occurred among 19 patients; the incremental risk for young age was evident only in patients <3 months old. Eleven deaths (39%) occurred among 28 patients who underwent repair of the Taussig-Bing type of DORV, with no decrease in mortality rate in the current era. Inclusion of a venous switch in the repair was the only incremental risk factor. Twenty-four patients with more-or-less normally positioned great arteries or with D-malposition but with noncommitted VSDs or complete atrioventricular canal defects underwent repair, with 7 hospital deaths; only 1 death occurred in the 11 operated upon in the current era. Four patients with DORV and L-malposition underwent repair, with no deaths. Three patients with superior-inferior ventricles and inlet VSD were considered uncorrectable and received successful palliative procedures. Thus, results of repair in the current era are good in all subsets, even in infants, except for the Taussig-Bing heart. For this condition, a repair that does not include a venous switch is recommended. © 1983.
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    Digital Object Identifier (doi)

    Author List

  • Piccoli G; Pacifico AD; Kirklin JW; Blackstone EH; Kirklin JK; Bargeron LM
  • Start Page

  • 549
  • End Page

  • 554
  • Volume

  • 52
  • Issue

  • 5