Dr. Hisashi Nikaidoh has received international recognition for the landmark procedure that bears his name following 20 years of successful surgeries.
Children diagnosed with the rare triad of Transposition of the Great Arteries, Ventricular Septal Defect and Pulmonary Stenosis have a significantly improved prognosis after undergoing aortic translocation with reconstruction of the right ventricular outflow tract, commonly called the Nikaidoh procedure.
“The aortic translocation, or the Nikaidoh procedure as it is appropriately known, is a truly innovative approach to the surgical repair of many patients with transposition of the great arteries,” said Dr. Joseph M. Forbess, chief of cardiothoracic surgery at Children’s. “Perhaps equally important, moreover, is the fact that the long-term follow-up for patients receiving this procedure appears to be superior to other surgical strategies. With the introduction of this procedure, Dr. Nikaidoh has left a mark on congenital heart surgery that will last forever.”
Dr. Nikaidoh has been involved directly in 18 of his procedures since 1984 when he proposed his alternative to the Rastelli procedure, the classical treatment option for this combination of heart defects. “My version of the repair avoids the conduit of the Rastelli operation while providing a more direct route from the left ventricle to the aorta,” Dr. Nikaidoh said. “To me, this is the main advantage of the operation over the Rastelli repair. The long-term survival is clearly better than Rastelli.”
Dr. Thomas Yeh Jr., cardiothoracic surgeon at Children’s, presented a report at the Fourth World Congress showing his remarkable findings after following up with 17 patients who underwent the Nikaidoh procedure. “We were frankly a bit stunned at how well the left side of the heart was doing,” Dr. Yeh said. “Dr. Nikaidoh’s daring was to move the whole valve over rather than just patching within the ventricle.”
In the Nikaidoh Procedure, the aorta is switched, along with the aortic valve, and placed in the pulmonary position. This avoids leaks of a faulty pulmonary valve on the right side.
In addition, it is necessary to mobilize the coronary arteries, as is done in the Arterial Switch Operation. The pulmonary root is divided at the level of the pulmonary valve, which is excised. The outlet septum is excised, thereby removing the superior margin of the VSD. The aortic root is transposed posteriorly so that it lies primarily over the left ventricle. The VSD is closed with a patch, which is anchored to the aortic root at its superior margin. The pulmonary artery is connected to the right ventriculotomy with an anterior patch of pericardium.
Source: Children’s Medical Center and Lauren-Allen.com
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