Arterial switch operation for transposition of the great arteries: A single‐centre 32‐year experience

Vida, Vladimiro L.; Zanotto, Lorenza; Zanotto, Lucia; Triglia, Laura Torlai; Bellanti, Ermanno; Castaldi, Biagio; Padalino, Massimo; Gasperetti, Andrea; Battista, Francesca; Varnier, Maurizio; Stellin, Giovanni

doi:10.1111/jocs.14045

Cited by 18 publications

(18 citation statements)

References 22 publications

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“…However, the fiveyear survival in the current era is 93%, similar to the outcomes reported in literature. [10][11][12] Our 20-year survival without reoperation at 79% and 20-year freedom from reoperation at 87% are in line with current literature. [10][11][12] Five-year cumulative incidence of reoperation varied by era.…”

Section: Commentsupporting

confidence: 90%

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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: 90%

“…[10][11][12] Our 20-year survival without reoperation at 79% and 20-year freedom from reoperation at 87% are in line with current literature. [10][11][12] Five-year cumulative incidence of reoperation varied by era. Although the differences were statistically significant, the absolute difference was small.…”

Section: Commentsupporting

confidence: 90%

Risk Factors for Reoperation After Arterial Switch Operation

Patel

Herrmann

Bain

et al. 2021

World J Pediatr Congenit Heart Surg

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“…Arterial switch operation for transposition of the great arteries has been performed with excellent outcomes. 1 Our experiences showed very satisfactory outcomes, and only two among 77 arterial switch operations required surgical intervention for asymptomatic coronary arterial stenosis during long-term follow-up. 2 Despite the scarcity of coronary insufficiency after arterial switch operation, Choi et al reported a successful coronary artery bypass graft in a 3-month-old male.…”

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confidence: 68%

Percutaneous coronary intervention in a 4-month-old infant for stenosis of both coronary arteries after arterial switch operation for transposition of the great arteries

2021

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We present a case of percutaneous coronary intervention in a 4-month-old infant with both severe coronary stenosis and acute heart failure after arterial switch operation for transposition of the great arteries. Under extracorporeal membrane oxygenation, balloon angioplasty of the left coronary artery with a 2.0 × 15-mm balloon and stent implantation on the right coronary artery with a 2.25 × 26-mm stent were performed successfully. Echocardiography after the intervention showed recovered cardiac function and no complications.

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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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Arterial switch operation for transposition of the great arteries: A single‐centre 32‐year experience

Cited by 18 publications

References 22 publications

Risk Factors for Reoperation After Arterial Switch Operation

Risk Factors for Reoperation After Arterial Switch Operation

Percutaneous coronary intervention in a 4-month-old infant for stenosis of both coronary arteries after arterial switch operation for transposition of the great arteries

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

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