Bex-Nikaidoh Procedure for Complex Transposition of Great Arteries With Ventricular Septal Defect and Left Ventricular Outflow Tract Obstruction: A Case Report

Several surgical approaches have been proposed to correct the transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO). Unlike the traditional procedures such as the Rastelli and Réparation à l'Etage Ventriculaire (REV) procedure, which often necessitate reoperation due to right or left ventricular outflow tract obstruction, the Bex-Nikaidoh procedure involves the translocation of both the aortic and pulmonary roots to achieve anatomically correct outflow alignment for both ventricles. Although technically demanding, this technique effectively addresses the anatomical challenges such as inlet or restrictive VSD and hypoplastic right ventricle. Recent studies indicate encouraging mid-term results, including high survival rate, preserved left ventricular function, and lower incidence of reoperation. We present a case report of a child with TGA, VSD, and pulmonary stenosis who successfully underwent the Bex-Nikaidoh procedure, detailing our operative technique, perioperative assessment, and management, thereby contributing to the evolving landscape of surgical repair for complex TGA with VSD and LVOTO.