RESULT OF BIVENTRICULAR REPAIR FOR DOUBLE-OUTLET RIGHT VENTRICLE

The choice of optimal repair for many patients with double-outlet righ t ventricle continues to challenge the heart surgeon. We present the r esults of a 10-year surgical experience with the biventricular repair for double-outlet right ventricle with situs solitus and atrioventricu lar concordance. Preoperative anatomic findings within this population of 73 patients are detailed. These morphologic features are correlate d with type of anatomic repair and clinical outcome. Patients were cla ssified by ventricular septal defect location. Normal coronary anatomy was found in the majority of patients with subaortic and doubly-commi tted ventricular septal defects. Patients with subpulmonary and noncom mitted ventricular septal defects had a wide variety of coronary anato my. Patients with subpulmonary and noncommitted ventricular septal def ects also-had a considerably higher prevalence of aortic arch obstruct ion. A tricuspid-to-pulmonary annular distance equal to or greater tha n the diameter of the aortic anulus was found to indicate the possibil ity of achieving a conventional ventricular septal defect-to-aorta int raventricular tunnel repair. Tricuspid-to-pulmonary annular distance s ufficient for intraventricular tunnel repair predominates in those pat ients with a tight posterior or right side-by-side aorta. Five types o f repair were used during-the study period: intraventricular tunnel re pair, arterial snitch with ventricular septal defect-to-pulmonary arte ry baffle; Rastelli-type extracardiac conduit repair, Damus-Kaye-Stans el repair, and atrial inversion with ventricular septal defect-to-pulm onary artery baffle. Overall actuarial survival estimate at 8 years is 81%. The presence of multiple ventricular septal defects and patient weight lower than the median were nearly significant risk factors for early mortality (p < 0.06). Nineteen patients (26%) required 24 reoper ations. Patients with subaortic ventricular septal defects were signif icantly reoperation free (p < 0.05). Patients with noncommitted ventri cular septal defects were at significantly higher risk for reoperation during the study period (p < 0.05). The prevalence of late right or l eft ventricular outflow obstruction in the nonsubaortic groups is conc erning. The median age at rc:pair in this series was 0.76 years, and t here was a nonsignificant trend (p = 0.13) for early mortality in pati ents younger than 1 year of age. These patients tended to have other s erious cardiac anomalies associated with double-outlet right ventricle that necessitated early operation. On the basis of these data, we fav or early repair for double-outlet right ventricle if possible.