title: Implications of incising the ventricular septum in double outlet right ventricle and in the Ross-Konno operation.
abstract: OBJECTIVE
  Incision into the ventricular septum in complex biventricular repair is controversial, and has been blamed for impairing left ventricular function. This retrospective study evaluates the risk of a ventricular septal incision in patients undergoing double outlet right ventricle (DORV) repair and Ross-Konno procedure.
  
  
  METHODS
  From January 2003 to September 2007, 11 patients with DORV had a ventricular septum (VS) incision and 12 DORV patients did not. Sixteen patients had a Ross-Konno, and 16 had an isolated Ross procedure. The ventricular septal incision was made to match at least the diameter of a normal aortic annulus. In DORV, the VSD was enlarged superiorly and to the left. In the Ross-Konno, the aortic annulus was enlarged towards the septum posteriorly and to the left.
  
  
  RESULTS
  The median follow-up for the study is 19 months (1 month-4 years). For DORV, there were no significant differences in discharge mortality (p=0.22), late mortality (p=0.48), or late mortality plus heart transplant (p=0.093). Although patients with DORV and VSD enlargement have a more complex postoperative course, there were no differences in ECMO use (p=0.093), occurrence of permanent AV block (p=0.55), left ventricular ejection fraction (LVEF) (p=0.40), or shortening fraction (LVSF) (p=0.50). Similarly, for the Ross-Konno there were no significant differences in discharge mortality (p=0.30), late mortality (p=NS), LVEF (p=0.90) and LVSF (p=0.52) compared to the Ross, even though the Ross-Konno patients were significantly younger (p<0.0001).
  
  
  CONCLUSIONS
  Making a ventricular septal incision in DORV repair and in the Ross-Konno operation does not increase mortality and does not impair the LV function. The restriction of the VSD remains an important issue in the management of complex DORV. These encouraging results need to be confirmed by larger series.
authors.affiliation: The Children's Hospital Heart Institute, Denver, CO, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Goldberg
authors.forename: Anthony C
authors.initials: AC
authors.lastname: McCanta
authors.forename: David N
authors.initials: DN
authors.lastname: Campbell
authors.forename: Esther V
authors.initials: EV
authors.lastname: Carpenter
authors.forename: David R
authors.initials: DR
authors.lastname: Clarke
authors.forename: Eduardo
authors.initials: E
authors.lastname: da Cruz
authors.forename: David D
authors.initials: DD
authors.lastname: Ivy
authors.forename: François G
authors.initials: FG
authors.lastname: Lacour-Gayet
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery*; D002675:Child, Preschool; D004310:Double Outlet Right Ventricle / Q000601:surgery*; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology; D054088:Ventricular Septum / Q000601:surgery*