Reoperation after the arterial switch operation for transposition of the great arteries

Abstract

Although most children after an arterial switch operation for transposition of the great arteries have normal development and cardiac function, a few require reoperation. During the last 10 years, 68 of 753 patients who underwent arterial switch operations (9.3%) underwent 75 reoperations. Thirty underwent early reoperation (< 30 days or during the same hospital stay) and 38 underwent late reoperation. Causes for reoperation included pacemaker insertion (n = 5), left diaphragm plication (n = 4), revision for hemostasis (n = 1), mediastinitis (n = 2), superior vena cava thrombosis (n = 9), subvalvular pulmonic stenosis (n = 5), supravalvular pulmonic stenosis (n = 16), residual atrial (n = 2) or ventricular (n = 8) septal defects, isolated mitral valve insufficiency (n = 2), aortic valve insufficiency (either isolated [n = 1] or in association with mitral incompetence [n = 1] or stenosis [n = 1]), left coronary artery ostial stenosis (n = 1), and recurrent aortic (n = 6) or neoaortic (n = 4) aortic coarctation. In all but 27 patients, the residual defects were already present immediately after the completion of the arterial switch operation; however, only patients with critical lesions were reoperated on early. Interventional catheterization procedures were performed when indicated; however, they only postponed inevitable reoperation. Successful relief of superior vena cava thrombosis was achieved by atriojugular bypass grafting in two patients, by early open thrombectomy in six patients, and by direct patch angioplasty of the superior vena cava once. Patch plasty for subvalvular or supravalvular pulmonic stenosis was carried out in 21 patients, septal defect closure was carried out in nine patients, and pulmonary artery banding was performed in one patient with criss-cross atrioventricular relationship and multiple ventricular septal defects. Valve repair was performed in all five patients with either isolated or combined aortic and mitral valve dysfunction. One patient with left coronary ostial stenosis underwent a patch enlargement of this ostium. Recoarctation was repaired by end-to-end anastomosis in eight patients and by a subclavian flap and a patch angioplasty in one patient each. Seven patients underwent a second reoperation for supravalvular pulmonary stenosis (n = 3), mitral valve replacement (n = 1), ventricular septal defect closure (n = 1), and recurrent coarctation (n = 2). There were six intraoperative (8.8%) and two late deaths. All early deaths occurred after early reoperations.(ABSTRACT TRUNCATED AT 400 WORDS)

Follow-up of our patients with transposition of the great arteries and arterial switch operation; comparison of simple and complex transposition cases

“…Bu ameliyatta deneyimi 25 yılı bulan bir kliniğin verileri incelendiğinde ASO'da genel perioperatif mortalite %15 iken, son 5 yıl içinde %4, hatta basit tip transposizyonda %0 olarak bildirilmiştir (8). ASO'dan sonra erken komplikasyonlara yönelik reoperasyon sebepleri arasında hemostaz problemleri, mediastinit, diyafram paralizi, kalp pili yerleştirilmesi bulunurken; geç dönem komplikasyonlara bağlı reoperasyonlar arasında ise neopulmoner arter stenozları, neoaortik yetersizlik, koroner arter problemleri rezidüel atriyal septal defekt, VSD, reküren aort koarktasyonu, mitral yetersizlik ve mitral stenoz sayılmaktadır (17)(18)(19). Serraf.…”

“…Serraf. ve ark.ları (18) geniş bir seride reoperasyon uygulanan hasta oranını % 9.3 olarak bildirmiştir. Bizim çalışma grubumuzda ise toplam 8 hastaya (%10.5) reoperasyon işlemi uygulanmıştır.…”

Prevalência e abordagem cirúrgica da estenose supravalvar pulmonar pós-operação de jatene para transposição das grandes artérias

“…The original surgical technique described by Jatene, although still currently used by some surgeons, has given place to a pattern of correction that encompasses basically the use of Lecompte maneuver, translocation of the coronary arteries with large fragment of the aortic wall, use of technical resources (trap-door) to aid the implantation of the coronaries and neopulmonary reconstruction with large fragments of synthetic tissue (Gore-tex), bovine or autologous pericardium (fresh or fixed) [12][13][14][15] .…”

Restoration of Transposed Great Arteries With or Without Subpulmonary Obstruction to Nature

“…Neo-aortic kinking is the narrowing of the aortic arch window and may become slit-like, can also be called aortic neocoarctation (Figure 3, Chiu et al, 2010;Muster et al, 1987). One group reported an incidence of 0.54% (Serraf et al, 1995). A coarctation is not present and the arch is wide open before conventional ASO with Lecompte maneuver.…”

“…Therfore, aortic neocaorctation was reported (Muster et al, 1987;Serraf et al, 1995). Most interestingly, we used computational fluid dynamics on mathematic modeling to compare flow phenomena of the spiral and nonspiral models (Figure 11).…”