Risk Factors For Reoperation After Arterial Switch Operation
Parth M. Patel, MD, Jeremy L. Herrmann, MD, Eric Bain, BS, Cameron Colgate, BS, Joseph M. Ladowski, MD, PhD, Mark D. Rodefeld, MD, Mark W. Turrentine, MD, John W. Brown, MD.
Indiana University School of Medicine, Indianapolis, IN, USA.
Objective: The longer-term outcomes of the Arterial Switch Operation in the setting of D-transposition of the great arteries remain unclear especially with regards to reoperation. Methods: 405 patients who underwent arterial switch operation between 1986 and 2018 were retrospectively reviewed. Patients were grouped by year of operation into eras: Era 1: 1980-1989; Era 2: 1990-1999; Era 3: 2000-2009; Era 4: 2010-2018. Multivariate analysis was used to identify risk factors for reoperation. Results: Median follow-up was 8.6 years (IQR 2-16.9). Early mortality decreased from 23.5% in Era 1 to 3.2% in Era 4 (p=0.047). Pulmonary arterioplasty for supravalvar pulmonary stenosis (SVPS) was the most common reoperation (n=11, 2.7%) 3.3 years (IQR 1.4-11.4) postoperatively. Right ventricular outflow tract reconstruction (RVOTR) was required in 9 patients (2.2%) 2.5 years (IQR 1.1-5.3) postoperatively. Aortic valve replacement or repair (AVR/r) was required in 7 patients (1.7%) 13.6 years (IQR 10.0-15.8) postoperatively. Aortic root replacement (ARR) and CABG/coronary patch arterioplasty were required in 5 patients (1.2%) 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 SVPS (p=0.009) and a risk factor for any reoperation (p=0.034). Risk factors for specific reoperations included ventricular septal defect for AVR/r (p=0.038), Taussig-Bing anomaly for RVOTR (p=0.004), and PA banding for ARR (p=0.028). Conclusions: 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 sub-populations will be critical to optimizing lifelong outcomes.
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