En Block Rotation of the Outflow Tracts: Intermediate Follow up after 15 Years of Experience.

Abstract Background The en bloc rotation of the outflow tracts is a surgical option for anatomic repair of transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction with preserved growth potential in all tubular structures and the option for keeping the native pulmonary valve. The aim of this study was to analyze our 15-year experience with this operation. Methods A retrospective single center study including 27 consecutive patients, who underwent the en bloc-rotation between 2003 and 2019, was carried out. Median age at surgery was 103 days [17; 117days], median body weight 5.2kg [3.66; 8.4kg]. 6 patients had 1-4 previous operations. In 18 cases (66.7%) the pulmonary valve could be preserved, in 9 cases (33.3%) a transanular patch was performed. Median follow up is 5.7 years [1.6; 9.0 years]. Results One patient died of chronic left ventricular failure during the hospital stay. Two more deceased after discharge: 1 aspiration after cerebral hemorrhage, 1 sudden death. Five other patients had to be reoperated or had reinterventions: 1 VSD closure, 1 aortic valve repair, 1 patch plasty and 2 dilatations of supravalvular pulmonary stenosis, 1 stent into a left pulmonary artery. During the follow-up period no gradient in the LVOT was found and postoperative growth of the pulmonary valve was shown. Conclusions The en bloc rotation allows an anatomic correction of the complex transposition with growth potential in all tubular structures. Reoperations or reinterventions on the pulmonary valve or on the LVOT have not been necessary until now.