Results of the arterial switch operation in neonates with transposed great arteries

Prêtre, René; Tamisier, Daniel; Bonhoeffer, Philipp; Mauriat, Philippe; Pouard, Philippe; Sidi, Daniel; Vouhé, Pascal

doi:10.1016/s0140-6736(00)04957-6

Cited by 221 publications

(159 citation statements)

References 15 publications

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“…Since the original description of the ASO in 1976, 8 modifications such as the Lecompte procedure, coronary artery relocation, and pulmonary artery reconstruction have likely contributed to improved perioperative outcomes. 9,[27][28][29][30] The association between the TaussigBing anomaly and poorer outcomes observed in our study has been previously described, 31 and postoperative complications, including hemorrhage, have been linked to increased Class III or IV 0 (0)…”

Section: Discussionsupporting

confidence: 62%

Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries

et al. 2013

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Background— Data regarding long-term outcomes after the arterial switch operation for D-transposition of the great arteries are scarce. Methods and Results— A single-institution retrospective cohort study was conducted to assess cardiovascular outcomes after an arterial switch operation between 1983 and 1999. Patients without follow-up visits within 3 years were contacted and secondary sources of information obtained. Overall, 400 patients, 154 (38.3%) with a ventricular septal defect, 238 (59.5%) with an intact septum, and 9 (2.3%) with a Taussig-Bing anomaly, were followed for a median of 18.7 years. In perioperative survivors, overall and arrhythmia-free survival rates at 25 years were 96.7±1.8% and 96.6±0.1%, respectively. Late mortality was predominantly a result of sudden deaths and myocardial infarction. At 25 years, 75.5±2.5% remained free from surgical or catheter-based reintervention. Freedom from an adverse cardiovascular event was 92.9±1.9% at 25 years. Independent predictors were a single right coronary artery (hazard ratio, 4.58; 95% confidence interval, 1.32-15.90), P =0.0166) and postoperative heart failure (hazard ratio, 6.93; 95% confidence interval, 1.57-30.62; P =0.0107). At last follow-up, the left ventricular ejection fraction was 60.3±8.9%, 97.3% had class I symptoms, and 5.2% obstructive coronary artery disease. Peak oxygen uptake was 35.1±7.6 mL/kg/min (86.1±15.1% predicted), with a chronotropic index <80% in 34.2%. At least moderate neoaortic and pulmonary regurgitation were present in 3.4% and 6.6%, respectively, and more than mild neoaortic and pulmonary stenosis in 3.2% and 10.3%. Conclusions— Long-term and arrhythmia-free survival is excellent after arterial switch operation. Although sequelae include chronotropic incompetence and neoaortic, pulmonary, and coronary artery complications, most patients maintain normal systolic function and exercise capacity.

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Section: Discussionsupporting

confidence: 62%

Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries

et al. 2013

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“…Later, when primary repair or rapid two-stage operation was the rule, AR prevalence decreased and ranged between 5% and 22% [43][44][45] . In most of the recent reports with a longer follow-up, AR prevalence was between 0.3% and 15% significantly lower than that of pulmonary stenosis or coronary stenosis 18,23,41,46 . In 172 patients, freedom from AR was 93.0% at 1 year, 85.2% at 5 years, and 77.9% at 10 years.…”

Section: Aortic Regurgitation Epidemiologymentioning

confidence: 84%

“…survival free of coronary events has been estimated as 92.7, 91, and 88.2% at 1, 10, and 15 years, respectively, while asymptomatic occlusion of the coronary arteries has been reported in up to 2% of hospital survivors [21][22][23][24] . Coronary events most often occur immediately after the AsO and are mainly related to coronary anatomy and to surgical technique difficulties.…”

Section: Coronary Complications and Ventricular Functionmentioning

confidence: 99%

Arterial switch operation for transposition of great arteries: late results in adult patients

Scognamiglio

Li²

2015

ICFJ

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Complete transposition of the great arteries (TGA) accountsfor 5% to 7% of congenital cardiac anomalies, and representsthe second most common cyanotic heart defect. Successfulsurgery, allowing the majority of patients to survive toadulthood, can either involve a physiologic or anatomic“correction”. The former (i.e. atrial switch), introduced in1958 by Senning and later modified by Mustard, corrects thephysiologic abnormality of the TGA by creating an atrial baffleto direct the venous return to the contralateral atrioventricularvalve and ventricle. Although mid-term clinical resultsare excellent, this procedure leaves the RV supporting thesystemic circulation. Hence, complications such as progressiveRV dysfunction, ensuing tricuspid regurgitation, frequentarrhythmias, heart failure and early mortality may arise in thelong-term5.

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“…1,8 In developed countries, there might be reasons like prematurity, sepsis or other major associated noncardiac conditions that will cause delay in immediate correction. Unfortunately, in developing countries, late presentation of d-TGA/IVS is not rare, and LVT will always be a surgical option in preparation for ASO.…”

Section: Discussionmentioning

confidence: 99%

Late Presenters with Dextro-transposition of Great Arteries and Intact Ventricular Septum: To Train or Not to Train the Left Ventricle for Arterial Switch Operation?

Parker

Zuhdi

Kouatli

et al. 2009

Congenital Heart Disease

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A B S T R A C TObjective. We report our experience in managing late presenters (older than 4 weeks) with dextro-transposition of great arteries and intact ventricular septum (d-TGA/IVS) in an effort to achieve successful arterial switch operation (ASO) in a third world setting. Design. We retrospectively reviewed the charts of all late presenters with d-TGA/IVS. Patients were divided into two groups: left ventricular training (LVT) group and non-left ventricular training (non-LVT) group. LVT group underwent pulmonary artery banding and Blalock-Taussig Shunt prior to ASO. Results. Twenty-one late presenters were included in the study. In LVT group, 11 patients with median age of 6 months (range, 1-72 months) underwent LVT. Later, 8 patients with median age of 9.25 months (range, 1.33-84 months) underwent ASO. Prior to ASO, left ventricle (LV) collapse resolved in all and left ventricle to systemic pressure (LV/SP) ratio was 0.81 (range, 0.76-0.95) in 4 patients. Two patients who had LVT for Յ14 days required postoperative extracorporeal membrane oxygenation (ECMO) support due to LV dysfunction. Seven patients survived to discharge. In non-LVT group, 10 patients with median age of 2.5 months (range, 1-98 months) underwent ASO. Five patients had LV collapse, and median LV/SP ratio was 0.67 (range, 0.56-1.19) in 5 patients. Seven patients needed ECMO support. Seven patients survived to discharge. Conclusion. Late presenters with d-TGA/IVS, who have LV collapse on echocardiography and/or a LV/SP ratio <0.67 on cardiac catheterization, should be subjected to LVT preferably for duration of longer than 14 days in order to avoid potential ECMO use.

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Results of the arterial switch operation in neonates with transposed great arteries

Cited by 221 publications

References 15 publications

Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries

Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries

Arterial switch operation for transposition of great arteries: late results in adult patients

Late Presenters with Dextro-transposition of Great Arteries and Intact Ventricular Septum: To Train or Not to Train the Left Ventricle for Arterial Switch Operation?

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