The Clinical Application and Results of Palliative Damus-Kaye-Stansel Procedure.
- Author:
Hong Gook LIM
1
;
Chang Ha LEE
;
Soo Jin KIM
;
Woong Han KIM
;
Seong Wook HWANG
;
Cheul LEE
;
Sung Ho SHINN
;
Kil Soo YIE
;
Jae Woong LEE
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Korea. leechha@sejongh.co.kr
- Publication Type:Original Article
- Keywords:
Congenital heart disease (CHD);
Damus-Kaye-Stansel procedure;
Ventricular outflow tract obstruction, left;
Pulmonary artery banding;
Aortic arch
- MeSH:
Aorta;
Aorta, Thoracic;
Bays;
Body Weight;
Cardiac Catheterization;
Cardiac Catheters;
Constriction, Pathologic;
Crisscross Heart;
Double Outlet Right Ventricle;
Echocardiography;
Follow-Up Studies;
Fontan Procedure;
Freedom;
Heart;
Heart Ventricles;
Humans;
Hypertension, Pulmonary;
Mitral Valve Insufficiency;
Multivariate Analysis;
Parturition;
Pulmonary Artery;
Reoperation;
Retrospective Studies;
Risk Factors;
Vascular Resistance
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2008;41(1):1-11
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. MATERIAL AND METHOD: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months (13 days~38.1 months) and body weight was 5.0 kg (2.9~13.5 kg). Preoperative pressure gradients were 25.3+/-15.7 mmHg (10~60 mmHg). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6, another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. RESULT: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of 62.7+/-38.9 months (3.3~128.1 months). Kaplan-Meier estimated actuarial survival was 71.9%+/-9.3% at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. CONCLUSION: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.
