The Modified Nikaidoh Procedure: Initial Experience and Short and Mid-term Outcomes

Claudia N. Villalba, Mariela Mouratian, María Victoria Lafuente, Julieta Irman, Ariel K. Saad, Jorge Barretta, Pablo García Delucis, José L. Pibernus, Alberto Sciegata, Horacio Capelli


Background: The Rastelli operation is the conventional procedure for transposition of the great vessels with ventricular septaldefect and pulmonary stenosis. Its results, however, are suboptimal and other surgical alternatives have been postulated. Arecent surgical technique, the Nikaidoh procedure, appears as a new therapeutic option.Objective: The aim of this study was to review our initial experience using the modified Nikaidoh procedure consisting inaortic translocation and biventricular outflow tract reconstruction.Methods: The study analyzed 11 consecutive patients operated on with the modified Nikaidoh procedure at our institutionbetween 2005 and 2014. Median age was 3 years (25-75% interquartile range: 1-5.5 years) and mean weight was 13.8 ± 5.4kg. Nine patients had transposition of the great vessels with ventricular septal defect and pulmonary stenosis and 2 haddouble outlet right ventricle with pulmonary stenosis and transposition physiology. All patients had a ventricular septal defectunrelated to the aorta and one patient also had a hypoplastic right ventricle.Results: There were no deaths in the immediate postoperative period. One patient developed infective endocarditis needingreoperation. Six patients had some degree of transient left ventricular dysfunction, and one patient only needed ventricular assistance. There was no involved right or left ventricular outflow tract obstruction and only mild aortic regurgitation. Atmid-term follow-up (mean of 5.5 ± 2.1 years, range: 2-8.6 years) there were no deaths or reoperations. An interventionalcardiac catheterization to dilate the right ventricle to pulmonary artery conduit was performed in one patient. All patientsremained in functional class I, with good biventricular function, free from arrhythmias, no left ventricular outflow tractobstruction and no significant aortic regurgitation.Conclusions: The Nikaidoh operation and its variants are a satisfactory surgical option for patients presenting transpositionof the great vessels with ventricular septal defect and pulmonary stenosis, who due to their morphology are inadequate candidatesfor a Rastelli procedure. In the mid-term follow-up, the left ventricular outflow tract remained without obstructionand there was no significant aortic valve regurgitation.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020