Sage Journals: Discover world-class research

Abstract

Objective:

The timing and nature of and risk factors for reoperation after the arterial switch operation in the setting of d-transposition of the great arteries requires further elucidation.

Methods:

A total of 403 patients who underwent arterial switch operation from 1986 to 2017 were reviewed. Institutional preference was for pulmonary artery reconstruction using a pantaloon patch of fresh autologous pericardium. The targets for coronary artery reimplantation were identified by intermittent root distension. Multivariable analysis was used to identify risk factors for reoperation.

Results:

Median follow-up was 8.6 years (interquartile range [IQR]: 2-16.9). Pulmonary arterioplasty was the most common reoperation (n = 11, 2.7%) at 3.3 years (IQR: 1.4-11.4) postoperatively. Subvalvar right ventricular outflow tract reconstruction (RVOTR) was required in nine (2.2%) patients at 2.5 years (IQR: 1.1-5.3) postoperatively. Aortic valve repair or replacement (AVR/r) was required in seven (1.7%) patients at 13.6 years (IQR: 10.0-15.8) postoperatively. Aortic root replacement (ARR) and Coronary Artery Bypass Graft/coronary patch arterioplasty were required in five (1.2%) patients each at 13.6 years (IQR: 11.0-15.3) and 11.3 years (IQR: 2.3-13.6) postoperatively, respectively. Taussig-Bing anomaly was a risk factor for any reoperation (P = .034). Risk factors for specific reoperations included ventricular septal defect for AVR/r (P = .038), Taussig-Bing anomaly for RVOTR (P = .004), and pulmonary artery banding for ARR (P = .028).

Conclusions:

Pantaloon patch pulmonary artery reconstruction and intermittent neo-aortic root distension during coronary reimplantation have minimized respective outflow tract reoperations. Certain anatomic subsets carry different risks for late reoperation, and pulmonary artery and/or RVOT reinterventions tend to occur sooner than aortic reinterventions. Special attention to these higher risk subpopulations will be critical to optimizing lifelong outcomes.

Keywords

arterial switch operation reoperation adult congenital heart disease pulmonary stenosis aortic root

Get full access to this article

View all access options for this article.

References

Fricke

Konstantinov

. Arterial switch operation: operative approach and outcomes. Ann Thorac Surg. 2019;107(1):302–310. doi:10.1016/j.athoracsur.2018.06.002

Jacobs

Mayer

Pasquali

, et al. The Society of Thoracic Surgeons Congenital Heart Surgery database: 2019 update on outcomes and quality. Ann Thorac Surg. 2019;107(3):691–704. doi:10.1016/j.athoracsur.2018.12.016

Villafañe

Lantin-Hermoso

Bhatt

, et al. D-transposition of the great arteries: the current era of the arterial switch operation. J Am Coll Cardiol. 2014;64(5):498–511. doi:10.1016/j.jacc.2014.06.1150

Raju

Burkhart

Durham

, et al. Reoperation after arterial switch: a 27-year experience. Ann Thorac Surg. 2013;95(6):2105–2112; discussion 2112-3. doi:10.1016/j.athoracsur.2013.02.040

Oda

Nakano

Fujita

Sakaguchi

Kado

. Long-term growth of the neoaortic root after arterial switch operation. Ann Thorac Surg. 2019;107(4):1203–1211. doi:10.1016/j.athoracsur.2018.09.025

Nakayama

Shinkawa

Matsumura

Hoki

Kobayashi

Niinami

. Late neo-aortic valve regurgitation long after arterial switch operation. Ann Thorac Surg. 2019;108(4):1210–1216. doi:10.1016/j.athoracsur.2019.04.009

Ahlström

Odermarsky

Malm

Johansson Ramgren

Hanseus

Liuba

. Surgical age and morbidity after arterial switch for transposition of the great arteries. Ann Thorac Surg. 2019;108(4):1242–1247. doi:10.1016/j.athoracsur.2019.04.033

Daebritz

Nollert

Sachweh

Engelhardt

von Bernuth

Messmer

. Anatomical risk factors for mortality and cardiac morbidity after arterial switch operation. Ann Thorac Surg. 2000;69(6):1880–1886. doi:10.1016/s0003-4975(00)01241-8

Santens

Van De Bruaene

De Meester

, et al. Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study. Int J Cardiol. 2020;316:94–100. doi:10.1016/j.ijcard.2020.04.072

10.

Fricke

d’Udekem

Richardson

, et al. Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Ann Thorac Surg. 2012;94(1):139–145. doi:10.1016/j.athoracsur.2012.03.019

11.

Vida

Zanotto

Triglia

, et al. Arterial switch operation for transposition of the great arteries: a single-centre 32-year experience. J Card Surg. 2019;34(11):1154–1161. doi:10.1111/jocs.14045

12.

Fraser

Chacon-Portillo

Well

, et al. Twenty-three-year experience with the arterial switch operation: expectations and long-term outcomes. Semin Thorac Cardiovasc Surg. 2020 Summer;32(2):292–299. doi:10.1053/j.semtcvs.2020.01.004

13.

Mavroudis

Stewart

Backer

Rudra

Vargo

Jacobs

. Reoperative techniques for complications after arterial switch. Ann Thorac Surg. 2011;92(5):1747–1754; discussion 1754-5. doi:10.1016/j.athoracsur.2011.04.102

14.

Vargo

Mavroudis

Stewart

Backer

. Late complications following the arterial switch operation. World J Pediatr Congenit Heart Surg. 2011;2(1):37–42. doi:10.1177/2150135110386976

15.

Idriss

Ilbawi

DeLeon

, et al. Arterial switch in simple and complex transposition of the great arteries. J Thorac Cardiovasc Surg. 1988;95(1):29–36.

16.

Van Praagh

. What is the Taussig-Bing malformation? Circulation. 1968;38(3):445–449. doi:10.1161/01.cir.38.3.445

17.

Vida

Zanotto

Stellin

, et al. Left-sided reoperations after arterial switch operation: a European multicenter study. Ann Thorac Surg. 2017;104(3):899–906. doi:10.1016/j.athoracsur.2017.04.026

18.

Losay

Touchot

Capderou

, et al. Aortic valve regurgitation after arterial switch operation for transposition of the great arteries: incidence, risk factors, and outcome. J Am Coll Cardiol. 2006;47(10):2057–2062. doi:10.1016/j.jacc.2005.12.061

19.

Raisky

Bergoend

Agnoletti

, et al. Late coronary artery lesions after neonatal arterial switch operation: results of surgical coronary revascularization. Eur J Cardiothorac Surg. 2007;31(5):894–898. doi:10.1016/j.ejcts.2007.02.003

20.

Jung

Kwak

Kim

, et al. Reoperation for coronary artery stenosis after arterial switch operation. Interact Cardiovasc Thorac Surg. 2018;27(2):169–176. doi:10.1093/icvts/ivy077

21.

Legendre

Losay

Touchot-Koné

, et al. Coronary events after arterial switch operation for transposition of the great arteries. Circulation. 2003;108(suppl 1):II186–II190. doi:10.1161/01.cir.0000087902.67220.2b

22.

Moll

Michalak

Sobczak-Budlewska

, et al. Coronary artery anomalies in patients with transposition of the great arteries and their impact on postoperative outcomes. Ann Thorac Surg. 2017;104(5):1620–1628. doi:10.1016/j.athoracsur.2017.03.078

23.

Angeli

Formigari

Pace Napoleone

, et al. Long-term coronary artery outcome after arterial switch operation for transposition of the great arteries. Eur J Cardiothorac Surg. 2010;38(6):714–720. doi:10.1016/j.ejcts.2010.03.055

24.

Spiegelenberg

Hutter

van de Wal

Hitchcock

Meijboom

Harinck

Late re-interventions following arterial switch operations in transposition of the great arteries. Incidence and surgical treatment of postoperative pulmonary stenosis. Eur J Cardiothorac Surg. 1995;9(1):7–10; discussion 10 -1. doi:10.1016/s1010-7940(05)80041-7

25.

Nellis

Turek

Aldoss

Atkins

. Intervention for supravalvar pulmonary stenosis after the arterial switch operation. Ann Thorac Surg. 2016;102(1):154–162. doi:10.1016/j.athoracsur.2016.01.068

26.

van der Palen

RLF

van der Bom

Dekker

, et al. Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation. Heart. 2019;105(22):1732–1740. doi:10.1136/heartjnl-2019-315157

27.

Fricke

Brizard

d’Udekem

Konstantinov

. Aortic root and valve surgery after arterial switch operation. J Thorac Cardiovasc Surg. 2012;144(5):1269–1271. doi:10.1016/j.jtcvs.2012.07.038

Risk Factors for Reoperation After Arterial Switch Operation

Abstract

Objective:

Methods:

Results:

Conclusions:

Keywords

Get full access to this article

References