Utilization and Outcomes of the Nikaidoh, Rastelli, and REV Procedures: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

Abstract Background Aortic Root Translocation (Nikaidoh), Rastelli, and Reparation a l’Etage Ventriculaire (REV) are repair options for transposition of the great arteries (TGA) with VSD and left ventricular outflow tract obstruction (VSD-LVOTO) or double outlet right ventricle (DORV) TGA type (DORV-TGA). Methods This retrospective study using the Society of Thoracic Surgeons Congenital Heart Surgery Database evaluates surgical procedure utilization and outcomes of patients undergoing repair of TGA-VSD-LVOTO and DORV-TGA with a Nikaidoh, Rastelli, or REV procedure. Results 293 patients underwent repair at 82 centers (January 2010-June 2019). Most patients underwent a Rastelli (n=165, 56.3%) or a Nikaidoh (n=119, 40.6%) operation; only 3.1% (n=9) underwent a REV. High-volume centers performed the majority of the repairs. Fewer Nikaidoh than Rastelli patients had prior cardiac operations (n=57; 48.7% vs n=102; 63.0%, p=0.004). Nikaidohs had longer median cardiopulmonary bypass (227 minutes [interquartile range (IQR) 167-299] vs 175 minutes [IQR 133-225], p Conclusions Rastelli and Nikaidoh procedures are the prevalent repair strategies for patients with DORV-TGA and TGA-VSD-LVOTO. Most are performed at high volume institutions and early outcomes are similar.