Twenty-eight years' experience of arterial switch operation for transposition of the great arteries in a single institution

Oda, Shinichiro; Nakano, Toshihide; Sugiura, Junya; Fusazaki, Naoki; Ishikawa, Shiro; Kado, Hideaki

doi:10.1093/ejcts/ezs033

Cited by 65 publications

(75 citation statements)

References 20 publications

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“…To this end, our study is unique in several respects, including the longest follow-up to date (median 18.7 years), 12,16,26,27 the comprehensive nature of the dataset (ie, physical examination, noninvasive imaging, hemodynamic studies, cardiopulmonary exercise testing, catheter and surgical interventions), and the arrhythmic and combined adverse cardiovascular outcomes. We deliberately restricted the study population to an early cohort (ie, with ASO between 1983 and 1999) to focus on long-term results.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, most previous longitudinal studies have reported an average follow-up of ≤10 years. 12,16,26,27 To maximize completeness of data collection, the catchment area was limited to patients living in New England. Moreover, data were supplemented by directly contacting patients and by acquiring records from secondary sources.…”

Section: Discussionmentioning

confidence: 99%

“…10 In perioperative survivors, the observed 96.7% actuarial survival rate at 25 years further extends results from previous longitudinal studies. 12,16,26,27 With the exception of 1 accidental death, all late fatalities were cardiovascular and attributable to myocardial infarction or sudden death of presumed arrhythmic etiology. Three of the 6 cardiovascular deaths occurred in infants, an observation consistent with studies suggesting a bimodal distribution of coronary events, with most transpiring during the first year of life.…”

Section: Discussionmentioning

confidence: 99%

“…Three of the 6 cardiovascular deaths occurred in infants, an observation consistent with studies suggesting a bimodal distribution of coronary events, with most transpiring during the first year of life. 16,32 Optimal screening remains a contentious issue, especially considering the fact that patients with ASO and denervated coronary arteries may not experience typical symptoms of angina. Some authors have, therefore, recommended serial coronary angiographic studies to identify potential lesions of concern.…”

Section: Discussionmentioning

confidence: 99%

“…Acute low cardiac output syndrome after ASO was also an independent predictor, a finding consistent with Losay et al's observation that major intensive care unit complications predict late mortality. 12 Whereas previous series have described high surgical reintervention rates during the first 5 years of follow-up, 12,16,26,27 we quantified this rate to be nearly 15% by 25 years. In addition, a high catheter intervention rate (ie, 18% at 25 years) was also observed.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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Comparison of Extracellular Matrix Patch and Standard Patch Material in the Pulmonary Arteries

et al. 2016

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After pulmonary artery (PA) patch augmentation, surgical or catheterization reintervention to address PA stenosis is not uncommon. Multiple patch materials are available and the need for reintervention may be related to characteristics of the patch material. In this retrospective chart review of patients who underwent PA augmentation from 2004 through 2013, we compare outcomes after PA augmentation with standard patch (SP) material and extracellular matrix (ECM) patch material. The primary outcome was reintervention-free survival (surgery or catheterization) using Kaplan-Meier survival analysis with the log-rank test. Risk factors for reintervention were assessed with Cox proportional hazard analyses. Baseline characteristics between groups were similar, except single-ventricle (SV) patients were more likely to have SP, and duration of follow-up was longer in the SP group. Median time to reintervention for all patients was 1099 days (95 % CI 646-1552 days). There was no difference in reintervention-free survival between the patch groups (p = 0.12); however, in multivariable analysis controlling for surgeon and patch, longer reintervention-free survival was associated with SV physiology (HR 0.57 95 % CI 0.34-0.95, p = 0.03) and aortic cross-clamp (XC) use (HR 0.52, 95 % CI 0.32-0.84, p = 0.008). Since there is no difference in median time to reintervention following PA augmentation with SP or ECM, patch choice should be determined by other factors, such as surgeon preference and cost. Longer reintervention-free survival in SV patients may be related to the set schedule of staged palliation. XC use may allow more extensive PA augmentation, thus protecting against the need for reintervention.

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Does Coronary Reimplantation After Neoaortic Reconstruction Increase Aortic Regurgitation?

et al. 2019

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Twenty-eight years' experience of arterial switch operation for transposition of the great arteries in a single institution

Abstract: ASO was performed with satisfactory results in the overall survival and functional status. PS was the main reason for re-operation. Coronary lesions can appear late without any symptoms. Benefits of ASO can be achieved by long-term follow-ups of PS, AI and coronary lesions.

Cited by 65 publications

References 20 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

Comparison of Extracellular Matrix Patch and Standard Patch Material in the Pulmonary Arteries

Does Coronary Reimplantation After Neoaortic Reconstruction Increase Aortic Regurgitation?

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