Three different surgical approaches for complex transposition of the great arteries with ventricular septal defect and pulmonary stenosis

The treatment of complex transposition of the great arteries with a ventricular septal defect and pulmonary stenosis/left outflow tract obstruction poses significant challenges. The decision between performing a Rastelli procedure, a Nikaidoh procedure or a double root rotation depends on the cardiac anatomy, especially the location of the ventricular septal defect, its spatial relationship with the great arteries, the presence of straddling of the atrioventricular valve and the appreciation of the pulmonary valve. In our centre, our goal is to provide the most physiologic repair tailored to each patient's unique anatomy and to try to preserve the pulmonary valve in the pulmonary position, despite some degree of residual stenosis. We demonstrate three different surgical techniques adapted for various anatomies: one en bloc double root rotation, one double root translocation with separation of the roots and one modified Nikaidoh procedure.