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The Clinical Outcomes of Damus-Kaye-Stansel Procedure According to Surgical Technique

  • Yang, Chan Kyu (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital) ;
  • Jang, Woo Sung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital) ;
  • Choi, Eun-Suk (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital) ;
  • Cho, Sungkyu (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital) ;
  • Choi, Kwangho (Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Nam, Jinhae (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital) ;
  • Kim, Woong-Han (Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital)
  • Received : 2013.09.02
  • Accepted : 2013.11.27
  • Published : 2014.08.05

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. Conclusion: 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.

Keywords

References

  1. Alsoufi B, Al-Wadai A, Khan M, et al. Outcomes of Damus-Kaye-Stansel anastomosis at time of cavopulmonary connection in single ventricle patients at risk of developing systemic ventricular outflow tract obstruction. Eur J Cardiothorac Surg 2014;45:77-82. https://doi.org/10.1093/ejcts/ezt251
  2. Lim HG, Lee CH, Kim SJ, et al. The clinical application and results of palliative Damus-Kaye-Stansel procedure. Korean J Thorac Cardiovasc Surg 2008;41:1-11.
  3. Shimada M, Hoashi T, Kagisaki K, Shiraishi I, Yagihara T, Ichikawa H. Clinical outcomes of prophylactic Damus-Kaye-Stansel anastomosis concomitant with bidirectional Glenn procedure. J Thorac Cardiovasc Surg 2012;143:137-43, 143.e1. https://doi.org/10.1016/j.jtcvs.2011.09.009
  4. Miura T, Kishimoto H, Kawata H, Hata M, Hoashi T, Nakajima T. Management of univentricular heart with systemic ventricular outflow obstruction by pulmonary artery banding and Damus-Kaye-Stansel operation. Ann Thorac Surg 2004;77:23-8. https://doi.org/10.1016/S0003-4975(03)01248-7
  5. Hiramatsu T, Imai Y, Kurosawa H, et al. Midterm results of surgical treatment of systemic ventricular outflow obstruction in Fontan patients. Ann Thorac Surg 2002;73:855-60. https://doi.org/10.1016/S0003-4975(01)03440-3
  6. Damus PS. Correspondence. Ann Thorac Surg 1975;20:724-5. https://doi.org/10.1016/S0003-4975(10)65775-X
  7. Kaye MP. Anatomic correction of transposition of great arteries. Mayo Clin Proc 1975;50:638-40.
  8. Stansel HC Jr. A new operation for d-loop transposition of the great vessels. Ann Thorac Surg 1975;19:565-7. https://doi.org/10.1016/S0003-4975(10)64433-5
  9. Waldman JD, Lamberti JJ, George L, et al. Experience with Damus procedure. Circulation 1988;78(5 Pt 2):III32-9.
  10. Laks H, Gates RN, Elami A, Pearl JM. Damus-Stansel-Kaye procedure: technical modifications. Ann Thorac Surg 1992;54:169-72. https://doi.org/10.1016/0003-4975(92)91174-8
  11. Gates RN, Laks H, Elami A, et al. Damus-Stansel-Kaye procedure: current indications and results. Ann Thorac Surg 1993;56:111-9. https://doi.org/10.1016/0003-4975(93)90413-C
  12. Freedom RM, Williams WG, Fowler RS, Trusler GA, Rowe RD. Tricuspid atresia, transposition of the great arteries, and banded pulmonary artery: repair by arterial switch, coronary artery reimplantation, and right atrioventricular valved conduit. J Thorac Cardiovasc Surg 1980;80:621-8.
  13. Huddleston CB, Canter CE, Spray TL. Damus-Kaye-Stansel with cavopulmonary connection for single ventricle and subaortic obstruction. Ann Thorac Surg 1993;55:339-45. https://doi.org/10.1016/0003-4975(93)90994-S
  14. Clarke AJ, Kasahara S, Andrews DR, et al. Mid-term results for double inlet left ventricle and similar morphologies: timing of Damus-Kaye-Stansel. Ann Thorac Surg 2004;78: 650-7. https://doi.org/10.1016/j.athoracsur.2004.03.005
  15. Masuda M, Tanoue Y, Ohno T, Tominaga R. Modified Damus-Kaye-Stansel procedure using aortic flap technique for systemic ventricular outflow tract obstruction in functionally univentricular heart. Eur J Cardiothorac Surg 2006;29: 1056-8. https://doi.org/10.1016/j.ejcts.2006.03.020
  16. Fiore AC, Rodefeld M, Vijay P, et al. Subaortic obstruction in univentricular heart: results using the double barrel Damus-Kaye Stansel operation. Eur J Cardiothorac Surg 2009;35:141-6. https://doi.org/10.1016/j.ejcts.2008.09.037
  17. Fujii Y, Kasahara S, Kotani Y, et al. Double-barrel Damus- Kaye-Stansel operation is better than end-to-side Damus- Kaye-Stansel operation for preserving the pulmonary valve function: the importance of preserving the shape of the pulmonary sinus. J Thorac Cardiovasc Surg 2011;141:193-9. https://doi.org/10.1016/j.jtcvs.2010.06.007
  18. Chang YH, Kim WH, Lee JY, et al. Pulmonary artery banding before the Damus-Kaye-Stansel procedure. Pediatr Cardiol 2006;27:594-9. https://doi.org/10.1007/s00246-006-1038-4

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