Reoperation for right ventricular outflow tract obstruction after arterial switch operation for transposition of the great arteries and aortic arch obstruction

Abstract

Taussig-Bing anomaly and smaller preoperative aortic annulus diameter (Z-score) were significant predictors of reoperation for RVOTO in patients after ASO for TGA or Taussig-Bing anomaly with AAO. In Taussig-Bing hearts, the more complex anatomy often necessitates modifications of the operation technique, sometimes precluding RVOT relief at primary ASO. During follow-up, the possibility of recurrent RVOTO should always be considered in this specific patient population. Yet, in case of a reoperation for RVOTO, the surgical relief is in general effective.

Arterial Switch Operation: Operative Approach and Outcomes

“…Reoperation is also higher in patients undergoing ASO with AAO repair [16,55,58]. We have previously reported a reintervention rate of 25.2% in patients with VSD and 23.4% in patients with AAO as compared with that of 5.9% in patients with an IVS at 15-year follow-up [6].…”

“…Only approximately 6% to 10% of children with IAA have TGA [52][53][54]. Because of the rarity of the combination of IAA and TGA, surgical experience is limited [10,11,16,55]. Although a 2-stage repair of IAA via thoracotomy and subsequent ASO can be performed [10,52], single-stage ASO with IAA repair is now the preferred approach [10,56].…”

“…Outcomes of single-stage ASO and AAO repair are limited to a few studies [10,16,55,58]. The AAO is a risk factor for mortality [6], with early mortality in these patients reported from 7.9% to 24% [6,16,55]. Low operative mortality after concomitant AAO repair can be achieved with [58] or without patch augmentation [6].…”

“…In as much as the need for reoperation for neo-ARD is infrequent, it may become more prevalent as the follow-up of these patients after ASO increases. It also appears that late PS and right ventricular outflow tract obstruction (RVOTO) are more common in patients with AAO, VSD, or TBA [16,55,[58][59][60][61]. Patients may be at a risk of late PS due to the native aortic annulus often being relatively small with or without concomitant RVOTO [55,58].…”

Commentary: Arterial switch and arch repair: One plus one doesn't always equal two

“…The main concern following repair is the development of right ventricular outflow tract obstruction (RVOTO), which was related to a large proportion of reinterventions in this study. Although some factors related to RVOTO, such as small aortic annulus and Taussig-Bing anomaly were identified 6,7 and effective relief of RVOTO by intervention is the rule rather than the exception, whether to manipulate the RVOT during repair is still a matter of debate. This article may leave readers noting a lack of analysis regarding RVOTO.…”