Nikaidoh Procedure

In 1984, Nikaidoh described the concept of aortic translocation for the management of transposition of the great arteries (TGA) with a ventricular septal defect (VSD) and pulmonary stenosis (PS). Patients with TGA/VSD/PS or double-outlet right ventricle (DORV) with malposed great vessels and PS who also present with a restrictive or inlet-type VSD, a hypoplastic right ventricle, or a straddling atrioventricular valve benefit the most from this complex procedure. This surgical technique avoids the creation of a long and tortuous intraventricular tunnel, as seen with the Rastelli procedure. It also creates more normally aligned right and left ventricular outflow tracts (RVOT and LVOT), which reduces the risk of recurrent LVOT obstruction and compression of the right ventricle (RV) to pulmonary artery (PA) connection by the sternum.

In the author’s opinion, the most important intraoperative surgical decisions include the management of the coronary arteries during aortic translocation (harvesting from the aortic root or not) and the reconstruction of the RV to PA connection (conduit, pulmonary root translocation, or direct PA to RV connection). When the great vessels are side-by-side, at least one of the coronary arteries needs to be reimplanted during translocation, but when they are anterior–posterior, commonly both coronary arteries can be left attached. Avoiding coronary ischemia is extremely important for a successful outcome. Also, the avoidance of an RV to PA conduit appears to reduce the incidence of reoperations.

Suggested Reading

1. Bex JP, Lecompte Y, Baillot F, Hazan E. Anatomic correction of transposition of the great arteries. Ann Thorac Surg. 1980;29(1):86-88.
2. Nikaidoh H. Aortic translocation and biventricular outflow tract reconstruction. A new surgical repair for transposition of the great arteries associated with a ventricular septal defect and pulmonary stenosis. J Thorac Cardiovasc Surg. 1984;88(3):365-372.
3. Morell VO, Jacobs JP, Quintessenza JA. Aortic translocation in the management of complex transposition of the great arteries with ventricular septal defect and pulmonary stenosis: results and follow-up. Ann Thorac Surg. 2005;79(6):2089-2093.
4. Morell VO. Nikaidoh procedure: how I teach it. Ann Thorac Surg. 2017;104(5):1446-1449.
5. Bautista-Hernandez V, Marx GR, Bacha EA, del Nido PJ. Aortic root translocation plus arterial switch for transposition of the great arteries with left ventricular outflow tract obstruction: intermediate-term results. J Am Coll Cardiol. 2007;49(4):485-490.
6. Jacobs ML, Pelletier G, Wearden PD, Morell VO. The role of Fontan’s procedure and aortic translocation in the surgical management of patients with discordant atrioventricular connections, interventricular communication, and pulmonary stenosis or atresia. Cardiol Young. 2006;16(suppl 3):97-102.
7. Yeh T, Ramaciotti C, Leonard SR, Roy L, Nikaidoh H. The aortic translocation (Nikaidoh) procedure: midterm results superior to the Rastelli procedure. J Thorac Cardiovasc Surg. 2007;133(2):461-469.