Options for coronary translocation and other considerations in aortic root translocation (Bex-Nikaidoh procedure)
Swaminathan Vaidyanathan1, Marathe Supreet2, Marathe Shilpa3, Alphonso Nelson2, Agarwal Vijay4
1 Department of Pediatric Cardiac Surgery, Apollo Children's Hospital, Chennai, Tamil Nadu, India
2 Department of Cardiac Surgery, Queensland Pediatric Cardiac Service, Queensland Children's Hospital; Department of Cardiac Surgery, Faculty of Medicine, University of Queensland, Brisbane, Australia
3 Department of Cardiac Surgery, Queensland Pediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Australia
4 Department of Pediatric Cardiac Surgery, Fortis Memorial Research Institute, Gurgaon, Haryana, India
Apollo Childrens Hospital, No. 15, Shafee Mohammed Road, Thousand Lights West, Chennai - 600 006, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: The surgical options for patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and left ventricular outflow tract obstruction include intracardiac baffling with the right ventricle to pulmonary artery (PA) conduit (Rastelli procedure), “reparation a l'etage ventriculaire” or aortic root translocation (Bex-Nikaidoh procedure). The Bex-Nikaidoh procedure allows a more normal, anatomically aligned left ventricular outflow tract. However, the operation is technically demanding, and coronary translocation remains one of the major challenges for successful root translocation.
Methods: All patients who underwent aortic root translocation in a single institute over a period of 2 years from January 2015 to December 2017 were included in the study. Surgical technique and early outcomes are described with specific focus on the different observed coronary artery patterns and surgical strategies for translocation.
Results: Fourteen patients underwent aortic root translocation. The coronary artery patterns observed could be categorized into four different patterns based on the size of the pulmonary annulus and the relative position of the PA relative to the aorta. Successful translocation of the coronary arteries was achieved in every patient. Mean follow-up was 18.42 ± 9.22 months. There was no mortality and no reoperation during the follow-up period.
Conclusion: The Bex-Nikaidoh procedure is a promising surgical option for TGA, VSD, and pulmonary stenosis. Good outcomes are achievable despite wide variations in anatomy using a tailored approach for coronary translocation.