title: The clinical outcomes of damus-kaye-stansel procedure according to surgical technique.
abstract: BACKGROUND
  The Damus-Kaye-Stansel (DKS) procedure is a method for mitigating the risk of systemic ventricular outflow tract obstruction (SVOTO). However, there have been few reports on which surgical technique shows a better outcome. The objective of this study was to compare the outcome of the DKS procedure according to the surgical technique used.
  
  
  METHODS
  We retrospectively reviewed 12 consecutive patients who underwent the DKS procedure from March 2004 to April 2013. When the relationship of the great arteries was anterior-posterior, the double-barrel technique (group A) was performed. If the relationship was side-by-side, the ascending aortic flap technique (group B) was performed.
  
  
  RESULTS
  There was no early mortality and 1 late mortality in group B. There was no statistically significant difference in the median peak pressure gradient of preoperative subaortic stenosis in both groups: 14 mmHg (range, 4 to 53 mmHg) in group A and 15 mmHg (range, 0 to 30 mmHg) in group B (p=0.526). Further, a significant postoperative pressure gradient was not observed in either group A or group B. More than moderate postoperative neoaortic regurgitation was observed in 1 patient of group B; this patient underwent neoaortic valve replacement 66 months after the DKS procedure. No one had a recurrent SVOTO during follow-up.
  
  
  CONCLUSIONS
  The DKS procedure is an effective way to minimize the risk of SVOTO, and there is little difference in the outcomes of the DKS procedure according to the surgical technique used.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital.
authors.forename: Chan Kyu
authors.initials: CK
authors.lastname: Yang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital.
authors.forename: Woo Sung
authors.initials: WS
authors.lastname: Jang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital.
authors.forename: Eun-Suk
authors.initials: ES
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital.
authors.forename: Sungkyu
authors.initials: S
authors.lastname: Cho
authors.affiliation: Pusan National University Yangsan Hospital, Pusan National University School of Medicine.
authors.forename: Kwangho
authors.initials: K
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital.
authors.forename: Jinhae
authors.initials: J
authors.lastname: Nam
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital.
authors.forename: Woong-Han
authors.initials: WH
authors.lastname: Kim
keywords: Congenital heart disease (CHD); Fontan operation; Great vessels; Pediatric