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Reoperation after arterial switch: a 27-year experience. Ann Thorac Surg 2013 Jun;95(6):2105-12; discussion 2112-3

Date

04/27/2013

Pubmed ID

23618522

DOI

10.1016/j.athoracsur.2013.02.040

Scopus ID

2-s2.0-84878237384 (requires institutional sign-in at Scopus site)   59 Citations

Abstract

BACKGROUND: The long-term outcome and spectrum of reoperation after the arterial switch operation (ASO) has not been fully defined, and there are limited data in the literature. We reviewed our institutional experience with reoperation(s) after ASO.

METHODS: Between January 1984 and January 2012, 32 patients (23 male) underwent reoperation(s) after ASO. Anatomy included simple transposition of the great arteries in 14, complex transposition of the great arteries in 14, and Taussig-Bing in 4. Mean age was 6.7 ± 1.4 years at first operation and 10.8 ± 13.4 years at the second operation. Isolated pathology was present in 11 (34.3%) and multiple pathologies in 21 (65.6%). Abnormalities at first reoperation were right-sided pathology in 18 (56.3%), left-sided pathology in 10 (31%), coronary artery in 3 (9%), mitral valve in 3 (9%), residual ventricular septal defect in 4 (12.5%), and recoarctation in 2 (6.3%). It was the second reoperation in 12 and the third reoperation in 3 patients.

RESULTS: The first reoperation included pulmonary artery patch plasty in 18, aortic valve operation in 8 (4 valve replacement, 3 root replacement, and 1 repair), pulmonary valve replacement in 4, coronary artery bypass grafting in 3, and mitral valve repair in 3. Multiple reoperations occurred in 15 patients, comprising right-sided procedures (11), left-sided (2), and other (2). Pulmonary artery reconstruction occurred earlier than neoaortic intervention (5.4 ± 6.8 vs 13.8 ± 7.7 years, p < 0.001). There were 2 early deaths (6.2%); both patients had complex transposition of the great arteries and both were at early reoperation after ASO. Median follow-up was 14.5 years (maximum, 27 years). There were no late deaths. Freedom from reoperation at 1, 5, and 15 years was 88%, 78%, and 41%, respectively.

CONCLUSIONS: The most common indication for reoperation after ASO is right-sided pathology, followed by neoaortic root pathology. Late survival after ASO is excellent and risk of late reoperation is low. Life-long medical surveillance is required.

Author List

Raju V, Burkhart HM, Durham LA 3rd, Eidem BW, Phillips SD, Li Z, Schaff HV, Dearani JA

Author

Lucian A. Durham MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Adolescent
Age Factors
Cardiac Surgical Procedures
Child
Child, Preschool
Cohort Studies
Female
Follow-Up Studies
Humans
Infant, Newborn
Male
Postoperative Complications
Pulmonary Artery
Reoperation
Retrospective Studies
Risk Assessment
Sex Factors
Survival Rate
Time Factors
Transposition of Great Vessels
Treatment Outcome
Ultrasonography
Young Adult