Twenty-Three-Year Experience With the Arterial Switch Operation: Expectations and Long-Term Outcomes

Fraser, Charles D.; Chacón-Portillo, Martin A.; Well, Andrew; Binsalamah, Ziyad M.; Adachi, Iki; Mery, Carlos M.; Heinle, Jeffrey S.

doi:10.1053/j.semtcvs.2020.01.004

Cited by 22 publications

(17 citation statements)

References 16 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%

“…[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%

“…The incidence of coronary reinterventions is 1% to 6% in the literature. 12,19,20 In the current series, those with normal coronary arrangement had a 25-year cumulative incidence of coronary reintervention of less than 1% and anomalous coronary anatomy patients had a 25-year cumulative incidence of coronary reintervention of 8%. We attribute our low coronary reintervention rate to taking generous coronary buttons and positioning them in such a way as to limit unintended kinking or twisting.…”

Section: Commentmentioning

confidence: 54%

“…These findings are similar to studies by Raju et al and others. 4,10,12 This complication may arise secondary to narrowing resulting from strain or tension at the pulmonary bifurcation due to inadequate branch mobilization prior to the LeCompte maneuver. 4 Abnormal relationships of the great vessels have been proposed as a risk factor for RVOTO, and we observed that Taussig-Bing anomaly was found to be a risk factor for pulmonary valve replacement and right ventricular outflow tract reconstruction.…”

Section: Commentmentioning

confidence: 99%

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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%

Section: Commentsupporting

confidence: 90%

Section: Commentmentioning

confidence: 54%

Section: Commentmentioning

confidence: 99%

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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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“…The ASO is performed worldwide with excellent results 16,17 ; however, certain subgroups of patients present additional surgical challenges. A recent study described the impact of coronary anatomy on outcomes of the ASO in 1033 children who had surgery between 1983 and 2013.…”

Section: Arterial Switch Operationmentioning

confidence: 99%

Highlights in congenital cardiothoracic surgery: 2020–2021

Buratto¹,

Konstantinov²

2021

The Journal of Thoracic and Cardiovascular Surgery

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Advances in congenital cardiothoracic surgery continue at a rapid pace. This year, for the first time, the Editorial Board of the Journal provides focused summaries of the key articles published in the American Association for Thoracic Surgery (AATS) journals during the year preceding the annual AATS meeting. These series of focused summaries will be published at the time of the AATS meetings. This particular compendium features articles on 3 topics: aortic valve surgery, the arterial switch operation (ASO), and atrioventricular septal defect (AVSD) repair.

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Statistical process monitoring creates a hemodynamic trajectory map after pediatric cardiac surgery: A case study of the arterial switch operation

Howsmon,

Mikulski,

Kabra

et al. 2024

Bioengineering & Transla Med

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Postoperative critical care management of congenital heart disease patients requires prompt intervention when the patient deviates significantly from clinician‐determined vital sign and hemodynamic goals. Current monitoring systems only allow for static thresholds to be set on individual variables, despite the expectations that these signals change as the patient recovers and that variables interact. To address this incongruency, we have employed statistical process monitoring (SPM) techniques originally developed to monitor batch industrial processes to monitor high‐frequency vital sign and hemodynamic data to establish multivariate trajectory maps for patients with d‐transposition of the great arteries following the arterial switch operation. In addition to providing multivariate trajectory maps, the multivariate control charts produced by the SPM framework allow for assessment of adherence to the desired trajectory at each time point as the data is collected. Control charts based on slow feature analysis were compared with those based on principal component analysis. Alarms generated by the multivariate control charts are discussed in the context of the available clinical documentation.

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Twenty-Three-Year Experience With the Arterial Switch Operation: Expectations and Long-Term Outcomes

Cited by 22 publications

References 16 publications

Risk Factors for Reoperation After Arterial Switch Operation

Risk Factors for Reoperation After Arterial Switch Operation

Highlights in congenital cardiothoracic surgery: 2020–2021

Statistical process monitoring creates a hemodynamic trajectory map after pediatric cardiac surgery: A case study of the arterial switch operation

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