Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study

Santens, Béatrice; Bruaene, Alexander Van De; Meester, Pieter De; Gewillig, Marc; Troost, Els; Claus, Piet; Bogaert, Jan; Budts, Werner

doi:10.1016/j.ijcard.2020.04.072

Cited by 32 publications

(24 citation statements)

References 24 publications

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“…This is similar to a recent study by Santens et al that demonstrated a 7.5% operative mortality over a 35-year follow-up period. 9 Our early operative mortality is similar to the recently published Congenital Heart Surgeons Society report by Jacobs et al 2 In addition, 15- and 30-year survival correlated. 9 Our initial institutional experience faced a steep learning curve, and we believe that this early learning curve is the reason for our long-term survival being lower than that reported in other more recent series.…”

Section: Commentsupporting

confidence: 87%

“…9 Our early operative mortality is similar to the recently published Congenital Heart Surgeons Society report by Jacobs et al 2 In addition, 15- and 30-year survival correlated. 9 Our initial institutional experience faced a steep learning curve, and we believe that this early learning curve is the reason for our long-term survival being lower than that reported in other more recent series. However, the five-year survival in the current era is 93%, similar to the outcomes reported in literature.…”

Section: Commentsupporting

confidence: 87%

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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: Commentsupporting

confidence: 87%

Section: Commentsupporting

confidence: 87%

Risk Factors for Reoperation After Arterial Switch Operation

Patel

Herrmann

Bain

et al. 2021

World J Pediatr Congenit Heart Surg

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“…Risk factors for early mortality are reported to be body weight less than 2.5 kg, resection for left ventricular outflow obstruction, concomitant aortic arch obstruction, prolonged CPB time. [ 12 , 13 ] Although our mortality seems to be relatively high, it should be kept in mind that these data encompass a wide range of data, including learning curve period of a newly established center. The first two arterial switch patients were emergency and non-referrable patients that had to be taken into operation before the implementation of the neonatal perfusion strategy and planning.…”

Section: Discussionmentioning

confidence: 94%

Is arterial switch operation possible with neonatology-focused intensive care unit modality

Doyurgan¹,

Özdemir²,

Akdeniz³

et al. 2021

Turk Gogus Kalp Dama

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Background: In this study, we aimed to examine the feasibility of arterial switch operation and its perioperative management with neonatology-focused intensive care modality in a region of Turkey where the birth rate and the number of asylum seekers who had to leave their country due to regional conflicts are high. Methods: Between December 2017 and June 2020, a total of 57 patients (48 males, 9 females; median age: 12.2 days; range, 2 to 50 days) who were diagnosed with transposition of the great arteries in our clinic and underwent arterial switch operation were retrospectively analyzed. All patients were followed by the neonatologist in the neonatal intensive care unit during the preoperative and postoperative period. Results: Thirty-eight (66.7%) patients had intact ventricular septum, 16 (28.1%) had ventricular septal defect, two (3.5%) had coarctation of the aorta, and one (1.7%) had Taussig-Bing anomaly. Coronary artery anomaly was present in 14 (24.5%) patients. The most common complications in the intensive care unit were renal failure requiring peritoneal dialysis in seven (12.3%) patients, supraventricular tachyarrhythmia in six (10.5%) patients, and eight (14%) patients left their chests open. The median length of stay in intensive care unit was 13.8 (range, 9 to 25) days and the median length of hospital stay was 24.5 (range, 16 to 47) days. The overall mortality rate for all patients was 12.3% (n=7). The median follow-up was 8.2 months. A pulmonary valve peak Doppler gradient of ≥36 mmHg was detected in five patients (8.7%) who were followed, and these patients were monitored by providing medical treatment. None of the patients needed reoperation or reintervention. Conclusion: We believe that arterial switch operation, one of the complex neonatal cardiac surgery, can be performed with an acceptable mortality and morbidity rate with the use of neonatology-focused intensive care modality, which is supported by pediatric cardiology and pediatric cardiac surgery.

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“…A total number of 993 ASO patients were followed for at least 18 years in the long-term follow-up cohort studies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] ( Table 1 ). Figure 3 A shows the freedom from coronary complications; the number at risk at 18 years is 993 patients.…”

Section: Resultsmentioning

confidence: 99%

The Coronary Arteries in Adults after the Arterial Switch Operation: A Systematic Review

Engele

Mulder

Schoones

et al. 2021

JCDD

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Coronary artery status in adults long after the arterial switch operation (ASO) is unclear. We conducted a systematic review to provide an overview of coronary complications during adulthood and to evaluate the value of routine coronary imaging in adults after ASO, in light of current guidelines. Articles were screened for the inclusion of adult ASO patients and data on coronary complications and findings of coronary imaging were collected. A total of 993 adults were followed with a median available follow-up of only 2.0 years after reaching adulthood. Myocardial ischemia was suspected in 17/192 patients (8.9%). The number of coronary interventions was four (0.4%), and coronary death was reported in four (0.4%) patients. A lack of ischemia-related symptoms cannot be excluded because innervation studies indicated deficient cardiac innervation after ASO, although data is limited. Anatomical high-risk features found by routine coronary computed tomography (cCT) included stenosis (4%), acute angle (40%), kinking (24%) and inter-arterial course (11%). No coronary complications were reported during pregnancy (n = 45), although, remarkably, four (9%) patients developed heart failure. The 2020 European Society of Cardiology (ESC) guidelines state that routine screening for coronary pathologies is questionable. Based on current findings and in line with the 2018 American ACC/AHA guidelines a baseline assessment of the coronary arteries in all ASO adults seems justifiable. Thereafter, an individualized coronary follow-up strategy is advisable at least until significant duration of follow-up is available.

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Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study

Cited by 32 publications

References 24 publications

Risk Factors for Reoperation After Arterial Switch Operation

Risk Factors for Reoperation After Arterial Switch Operation

Is arterial switch operation possible with neonatology-focused intensive care unit modality

The Coronary Arteries in Adults after the Arterial Switch Operation: A Systematic Review

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