Midterm follow-up of arterial switch operation for transposition of the great arteries with intact ventricular septum and left-ventricular outflow tract obstruction☆

Abstract

Mid-term outcomes of ASO for a highly selected group of patients with pulmonary valve annulus z-score ≤ -2.0 ≥ -0.4, resectable organic LVOTO, and dynamic peak LVOT gradient ≥40 mmHg remain satisfactory, with a need for long-term follow-up.

TGA + IVS + LVOTO: patterns of practice and outcomes

“…Raja and colleagues reported excellent outcomes with ASO in 13 patients with TGA þ IVS þ LVOTO, with no mortalities or reinterventions at mid-term follow-up. 5 A possible downside of this operation in patients with TGA þ IVS þ LVOTO is the higher incidence of neoaortic regurgitation in patients undergoing ASO compared to patients undergoing other biventricular repairs. This neoaortic regurgitation is possibly due to the need for resection of subvalvar tissue, which may distort supporting muscular tissues or injure pulmonary valve leaflets.…”

“…3,4 Another alternative that does provide an anatomic repair is performing an arterial switch operation (ASO) with or without LVOTO resection. 5,6 Another option is a modified Nikaidoh operation in cases where LVOTO is unresectable or where resection is associated with high risk of complications. 7 A modified Rastelli operation with creation of a subaortic ventricular septal defect (VSD) in the intact ventricular septum may also be considered.…”