American Association of Plastic Surgeons

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Mid-Term Outcomes After the Palliative Arterial Switch Operation in Neonates With Single-Ventricle Anatomy
Christopher E. Greenleaf, MD, Jeffrey Heinle, MD, Ziyad Binsalamah, MD, Carlos Mery, MD.
Texas Children's Hospital, Houston, TX, USA.

Objective(s): The palliative arterial switch operation (pASO) offers the theoretical advantage of avoiding systemic-to-pulmonary artery shunt physiology and posterior entrapment of the left pulmonary artery while aligning the single left ventricle with the posterior semilunar valve in newborns with single-ventricle anatomy, transposition of the great arteries, and systemic outflow obstruction. The purpose of this study was to update the outcomes for all of the patients that have undergone pASO at our institution.
Methods: We conducted a retrospective review of all neonates undergoing a pASO from July 1997 to January 2017.
Results: 22 patients underwent pASO at a median age of 7 days (2-40 days). Primary diagnoses included double-inlet left ventricle (10 patients [45%]), tricuspid atresia (9 patients [41%]), and other (3 patients [14%]). There were no deaths. All patients have advanced to a bidirectional cavopulmonary shunt. Fourteen patients had Fontan completion. Two patients have had confirmed coronary artery problems, with only one requiring re-intervention. 19 patients (86%) have required pulmonary artery patch augmentation. Two patients (9%) have moderate neo-aortic regurgitation. One patient required a cardiac transplant late after Fontan due to ventricular dysfunction. All other patients (21 patients [95%]) have no more than mild ventricular dysfunction at most recent follow up. All patients were alive at last follow-up (median, 7 years [5 months-18 years]).
Conclusions: The pASO should be considered for neonates with single ventricle anatomy, transposition of the great arteries, and systemic outflow obstruction. At mid-term follow-up, all patients had excellent survival and are favorable candidates for Fontan palliation.


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