Arterial Switch Operation: Operative Approach and Outcomes

Fricke, Tyson A.; Konstantinov, Igor E.

doi:10.1016/j.athoracsur.2018.06.002

Cited by 36 publications

(24 citation statements)

References 78 publications

(165 reference statements)

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“…Taussig-Bing anomaly per Van Praagh is "a double-outlet right ventricle with semilunar valves side-by-side and approximately at the same height, a bilateral conus, and a subpulmonary ventricular septal defect" and patients often have a relatively larger pulmonary artery and smaller ascending aorta. 1,16 Given this anatomy, it is easy to see why these patients are at risk for any reoperation in addition to rightsided reintervention as was seen in this series. Left-sided reoperations after ASO are not without risk, with a reported operative mortality of 6.3%.…”

Section: Commentmentioning

confidence: 75%

“…1 The ASO was not widely adopted until the mid-1980s. 1 Since then, operative mortality has improved significantly. 2,3 The first generation of patients who underwent the ASO, as opposed to the atrial switch, are now reaching their fifth decade of life.…”

Section: Introductionmentioning

confidence: 99%

“…The arterial switch operation (ASO) revolutionized the way we care for patients with d -transposition of the great arteries (d-TGA) by restoring a normal anatomic and physiologic cardiac configuration. 1 The ASO was not widely adopted until the mid-1980s. 1 Since then, operative mortality has improved significantly.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Reoperation After Arterial Switch Operation

Patel

Herrmann

Bain

et al. 2021

World J Pediatr Congenit Heart Surg

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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.

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Section: Commentmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Reoperation After Arterial Switch Operation

Patel

Herrmann

Bain

et al. 2021

World J Pediatr Congenit Heart Surg

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“…Atrial switch patients, after a Senning procedure, face a higher risk of atrial or ventricular arrhythmia as the right ventricle must maintain systemic circulation [3,4]. This patient cohort also requires regular follow-up imaging by echocardiography and MRI to recognise pathologies that need re-interventions, mostly concerning the right ventricular outflow tract [1,2,7,8].…”

Section: Introductionmentioning

confidence: 99%

Assessment of ventricular flow dynamics by 4D-flow MRI in patients following surgical repair of d-transposition of the great arteries

et al. 2021

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Objectives To use 4D-flow MRI to describe systemic and non-systemic ventricular flow organisation and energy loss in patients with repaired d-transposition of the great arteries (d-TGA) and normal subjects. Methods Pathline tracking of ventricular volumes was performed using 4D-flow MRI data from a 1.5-T GE Discovery MR450 scanner. D-TGA patients following arterial switch (n = 17, mean age 14 ± 5 years) and atrial switch (n = 15, 35 ± 6 years) procedures were examined and compared with subjects with normal cardiac anatomy and ventricular function (n = 12, 12 ± 3 years). Pathlines were classified by their passage through the ventricles as direct flow, retained inflow, delayed ejection flow, and residual volume and visually and quantitatively assessed. Additionally, viscous energy losses (ELv) were calculated. Results In normal subjects, the ventricular flow paths were well ordered following similar trajectories through the ventricles with very little mixing of flow components. The flow paths in all atrial and some arterial switch patients were more irregular with high mixing. Direct flow and delayed ejection flow were decreased in atrial switch patients’ systemic ventricles with a corresponding increase in residual volume compared with normal subjects (p = 0.003 and p < 0.001 respectively) and arterial switch patients (p < 0.0001 and p < 0.001 respectively). In non-systemic ventricles, arterial switch patients had increased direct flow and decreased delayed ejection fractions compared to normal (p = 0.007 and p < 0.001 respectively) and atrial switch patients (p = 0.01 and p < 0.001 respectively). Regions of high levels of mixing of ventricular flow components showed elevated ELv. Conclusions 4D-flow MRI pathline tracking reveals disordered ventricular flow patterns and associated ELv in d-TGA patients. Key Points • 4D-flow MRI can be used to assess intraventricular flow dynamics in d-TGA patients. • d-TGA arterial switch patients mostly show intraventricular flow dynamics representative of normal subjects, while atrial switch patients show increased flow disorder and different proportions of intraventricular flow volumes. • Flow disruption and disorder increase viscous energy losses.

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“…Primary arterial switch operation (ASO) has become the standard treatment of choice for transposition of the great arteries with intact ventricular septum (TGA/IVS) in the first few weeks of life [1] . However, there is no standard treatment protocol in patients older than three weeks of age.…”

Section: Introductionmentioning

confidence: 99%

Late Arterial Switch Surgery Under ECMO Support in a Patient with Transposition of the Great Arteries with Intact Ventricular Septum: a Case Report

Haydın¹,

Öztürk²,

Yıldız³

et al. 2020

Braz J Cardiovasc Surg

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A 30-month-old male patient with transposition of the great arteries with intact ventricular septum (TGA/IVS) is presented. Arterial switch operation (ASO) was performed in the light of echocardiographic and angiographic findings. The patient remained under extracorporeal membrane oxygenation support for seven days postoperatively, and his cardiac functions returned to normal at the postoperative 10 th day. He was discharged at the postoperative 20 th day. The present case, which presents one of the most advanced ages at operation for TGA/IVS among previously reported cases, is used to discuss late ASO in this study.

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Arterial Switch Operation: Operative Approach and Outcomes

Cited by 36 publications

References 78 publications

Risk Factors for Reoperation After Arterial Switch Operation

Risk Factors for Reoperation After Arterial Switch Operation

Assessment of ventricular flow dynamics by 4D-flow MRI in patients following surgical repair of d-transposition of the great arteries

Late Arterial Switch Surgery Under ECMO Support in a Patient with Transposition of the Great Arteries with Intact Ventricular Septum: a Case Report

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