Repair of XXXX in infancy with a transventricular or a transatrial approach.

@entity1 @entity215 @entity943 @entity1165
OBJECTIVE: The optimal time and approach of repair of @entity215 ( @entity215 ) remain controversial. The purpose of this study was to evaluate the outcome following repair of @entity215 in @entity1 with particular regard to the surgical approach used. @entity1 : One hundred and sixty @entity1 (mean age 195+/-89 days, range 11-364 days) undergoing repair of a simple @entity215 were studied. Between 1974 and 2000, a transventricular approach (RV) was used in 91 and between 1988 and 2000, a transatrial (RA) approach in 69 @entity1 . Ten of these @entity1 (6.2%) had a previous palliative shunt (four in the RV versus six in the RA group). A transannular patch (TAP) was inserted in 96 (60%) @entity1 (76 versus 20). Follow-up was complete (mean 14.5+/-5.2 versus 6+/-1 years). RESULTS: There were three operative deaths (1.9%), (two in RV versus one in RA group). A re-operation for right ventricular outflow tract obstruction (RVOTO) was performed in 19 @entity1 (3 versus 16). Ten-year freedom from re-operation for RVOTO (+/-standard error of the mean) was 88+/-4% (98+/-2 versus 72+/-6%, P<0.0001). Within the RA group, 5-year freedom from re-operation for RVOTO for those who had a TAP was 79+/-9% and it was 75+/-4% for those having a simple repair. Six @entity1 in the RV group required pulmonary valve replacement (PVR). Ten-year freedom from PVR was 98+/-1% (97+/-2 versus 100%, P=0.3). There were two late deaths, one in each group. Ten-year survival was 97+/-1%. One @entity1 in the RV group developed late recurrent @entity1165 requiring the implantation of a defibrillator. At most recent echocardiography, all but the @entity1 who had the defibrillator had good right and left ventricular function. CONCLUSIONS: Transventricular and transatrial repair of @entity215 in infancy, are associated with an acceptable operative risk, low incidence of late @entity943 , good bi-ventricular function and excellent survival. In our experience, however, transatrial repair has a disturbing incidence of early and mid-term residual or recurrent RVOTO, even when a TAP has been used.
