title: Modified Nikaidoh procedure for the correction of complex forms of transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction: mid-term results.
abstract: OBJECTIVE
  Different surgical techniques for the treatment of complex transposition of the great arteries (TGA) with ventricular septal defect and left ventricular outflow tract obstruction (LVOTO) have been developed, in particular the Rastelli operation, the réparation à l'étage ventriculaire procedure and the Nikaidoh procedure. The hitherto published results of the Nikaidoh procedure and its modifications compare favourably with those of other techniques; however, experience with the Nikaidoh procedure is still limited. Here, we report our institutions' early and mid-term results with modifications of the Nikaidoh procedure.
  
  
  METHODS
  Twenty-one patients who underwent a modified Nikaidoh procedure between 2006 and 2012 at our institution, either as aortic root translocation (n = 17) or as en bloc rotation of the arterial trunk (n = 4), were studied retrospectively.
  
  
  RESULTS
  There were 2 early and 1 mid-term deaths. The follow-up continued for a median of 2.3 years (range 0.3-6.4 years). During the follow-up, the performance of the reconstructed left ventricular outflow tract (LVOT) remained excellent: no reobstruction and no aortic valve regurgitation classified as more than mild were observed. Left ventricular function was well preserved. In 4 patients, a significant reoccurring right ventricular outflow tract obstruction due to conduit failure was observed; so far, two reoperations with conduit replacement have been necessary. The mean right ventricular outflow tract peak gradient was 24 ± 7.2 mmHg at the last follow-up in the remaining patients. No reobstruction of the right ventricular outflow tract occurred in patients with preserved pulmonary valve tissue after en bloc rotation.
  
  
  CONCLUSIONS
  The aortic translocation procedure is a valuable surgical option for patients with complex (TGA) with ventricular septal defect and LVOTO. The mid-term results document excellent performance of the reconstructed LVOT. Modifications of the Nikaidoh procedure that preserve pulmonary valve tissue may further reduce the need for right ventricular outflow tract reoperation.
authors.affiliation: Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kramer
authors.forename: Stanislav
authors.initials: S
authors.lastname: Ovroutski
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
authors.forename: Michael
authors.initials: M
authors.lastname: Hübler
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
keywords: Aortic root translocation; Complex transposition of the great arteries; Left ventricular outflow tract obstruction; Modified Nikaidoh procedure; Ventricular septal defect