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36. Bex-Nikaidoh operation and the impact of double root translocation on outcomes.

Author

Schulz, Antonia, Buratto, Edward, Ishigami, Shuta, Konstantinov, Igor E, Cheung, Michael M H, and Brizard, Christian P

Subjects
VENTRICULAR outflow obstruction, ARTIFICIAL blood circulation
Abstract

Open in new tab Download slide OBJECTIVES The Bex-Nikaidoh operation can effectively relieve left ventricular outflow tract obstruction. However, if a conduit is used for right ventricular outflow tract reconstruction, a late reoperation can be anticipated. We examined the impact of double root translocation on outcomes. METHODS We performed a retrospective single-centre study of patients who underwent aortic root translocation between 2006 and 2019. RESULTS Aortic root translocation was performed in 23 patients at a median age of 1.6 years [interquartile range (IQR) 0.9–2.5]. Concomitant repairs were done in 52.2% of patients (12/23) including the Senning atrial switch in 34.8% (8/23). The right ventricular outflow tract was reconstructed with valved conduits in 39.1% (9/23), direct anastomoses in 4.35% (1/23) and pulmonary autografts in 56.5% of patients (13/23). Aortic cross-clamp time was significantly longer in patients with double root translocation [308 min (IQR 270–259) vs 209 min (IQR 179–281), P  =   0.02]; 2 patients in this group required temporary mechanical circulatory support. There were no early deaths. Median follow-up time was 7.5 years (IQR 3.3–10.5). The estimated 10-year survival was 90% [95% confidence interval (CI): 47.3%, 98.5%]. There was no recurrent left ventricular outflow tract obstruction. Freedom from any reoperation was 64.2% (95% CI: 40.8%, 80.3%) at 3 years and 44.5% (95% CI: 21.2%, 65.5%) at 6 years. The main indication for late reoperation was conduit degeneration. Freedom from a right ventricular outflow tract reoperation was significantly higher, and the number of reoperations per patient was lower when a double root translocation had been performed (P  =   0.03). CONCLUSIONS The Bex-Nikaidoh operation effectively relieved left ventricular outflow tract obstruction. A double root translocation further increased procedural complexity but was associated with better mid-term freedom from a right ventricular outflow tract reoperation. It should be considered in suitable patients. [ABSTRACT FROM AUTHOR]

Published
2024
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50. Clinical assessment can be lifesaving: Salvage of catastrophic cerebral ischemia by conversion to central extracorporeal membrane oxygenation.

Author

Ivanov, Yaroslav, Buratto, Edward, Konstantinov, Igor E., Clifford, Michel, Brizard, Christian P., and Horton, Stephen

Subjects
EXTRACORPOREAL membrane oxygenation, CIRCLE of Willis, CATASTROPHIC illness, PEDIATRICS, CEREBRAL ischemia, DISEASE risk factors
Abstract

Peripheral veno-artertial extracorporeal membrane oxygenation (VA-ECMO) is commonly used in the paediatric population for intractable respiratory and cardiac failure. One of the devastating complications of VA-ECMO is severe brain damage due to ischemia or haemorrhage. We describe a case of peripheral cervical VA-ECMO complicated by evolving right cerebral ischemia which was rescued with rapid conversion from peripheral to central VA-ECMO support. Notably, the patient had a complete circle of Willis. Following conversion, we observed complete resolution of neurological symptoms with full functional recovery. [ABSTRACT FROM AUTHOR]

Published
2024
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