The choice of palliative arterial switch operation as an alternative for selected cases in a single center: Experience and mid term results

Abstract

Introduction and Objective There are various management options for newborns with single ventricle physiology, ventriculoarterial discordance and subaortic stenosis, classically involving the early pulmonary banding and aortic arch repair, the restricted bulboventriculer foramen enlargement or the Norwood and the Damus–Kaye–Stansel procedures. The aim of this study is to evaluate our preferred technique and comment on the midterm results of our clinical experience with palliative arterial switch operation (pASO) for a certain subset of patients. Method We hereby retrospectively evaluate the charts of patients who went through pASO, as initial palliation through Fontan pathway, starting from 2014 till today. Results Ten patients underwent an initial palliative arterial switch procedure. Eight of 10 patients survived the operation and discharged. Seven of 10 patients completed Stage II and 1 patient reached the Fontan completion stage and the other six of ten (6/10) patients are doing well and waiting for the next stage of palliation. There are two mortalities in the series (2/10) and one patient lost to follow‐up (1/10). Conclusion In our opinion, the pASO can be considered as an alternative palliation option for patients with single ventricle physiology, transposition of the great arteries and systemic outflow tract obstruction despite longer cross clamp times compared to other methods, but It not only preserves systolic and diastolic ventricular function, but also provides a superior anatomic arrangement for following stages.

Narrative review of single ventricle: where are we after 40 years?

“…For newborns with single ventricle physiology, ventriculo-arterial discordance and subaortic stenosis, hypoplasia of ascending aorta and aortic arch, various surgical options were introduced, classically involving early pulmonary banding and aortic arch reconstruction, with or without the enlargement of restricted bulbo-ventricular foramen, or the Damus-Kaye-Stansel procedure, associated with a new source of pulmonary blood flow, either with modified Blalock-Taussig shunt or with Sano right ventricle to pulmonary artery conduit (6,(86)(87)(88)(89)(90)(91)(92). An alternative approach introduced later was a palliative arterial or ventricular switch, both procedures requiring a longer aortic cross clamp times compared to other options but preserving systolic and diastolic ventricular function and providing a superior anatomic arrangement for the subsequent surgical stages (93)(94)(95)(96). Obstructed pulmonary venous connections is a quite rare but extremely severe complication in neonates with single ventricle physiology (97)(98)(99)(100)(101), but with proper pre-and post-operative imaging, recurrence can be monitored with reasonable outcomes (102).…”

Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstruction

“…The pASO was first proposed as an alternative strategy for patients with SV-TGA-SOO in the 1980s. 21 It has subsequently been successfully applied as initial palliation in the neonate and infant population 4 , 22 , 23 , 24 with successful promotion to Fontan. 4 , 23 , 24 , 25 Critiques of this approach include longer operative times, intraoperative complexity, and concern for coronary artery complications.…”

“… 21 It has subsequently been successfully applied as initial palliation in the neonate and infant population 4 , 22 , 23 , 24 with successful promotion to Fontan. 4 , 23 , 24 , 25 Critiques of this approach include longer operative times, intraoperative complexity, and concern for coronary artery complications. Proposed benefits include alignment of the dominant semilunar valve with the systemic circulation, eliminating the need for BVF enlargement, postponement or avoidance of shunt-dependent physiology, and preserved LPA accessibility.…”

The choice of palliative arterial switch operation as an alternative for selected cases in a single center: Experience and midterm results

“…To the Editor, Okan Yurdakök et al 1 's recently published article "The choice of palliative arterial switch operation as an alternative for selected cases in a single center: Experience and midterm results" piques our interest. The authors' efforts are significant and should be recognized by the readers.…”