Still Too Many Reoperations After The Arterial Switch Operation: 20 Years Of Experience
Arif Selcuk, Mahmut Ozturk, Rittal Mehta, Manan Desai, Aybala Tongut, Vanessa Sterzbecher, Can Yerebakan, Yves d'Udekem
Children's National Hospital, Washington, DC
Objective(s): To assess retrospectively our outcomes of the arterial switch operation (ASO) by analysis long-term of survival, reoperations, and interventions during follow-up.
Methods: The data of 180 patients with d-transposition of the great arteries (d-TGA) who underwent ASO between 2002-2022 were obtained.
Results: The patients were divided into TGA-intact ventricular septum (n=121), TGA-ventricular septal defect (n=47) and Taussig Bing Anomaly (TBA) (n=12) groups. The median follow-up time was 6 years (IQR:2-10 years). There were five early (2.8%) and one late (0.6%) mortalities. Reoperations were performed in 31 patients (17%). On multivariable analysis, the risk factors for reoperation were TBA (p=.0001, OR:17.31, 95%CI:4.12-72.70), history of pulmonary artery angioplasty (p=.0002, OR:5.54, 95%CI:2.27-13.54), mild or greater neo-aortic valve regurgitation (NAVR) at discharge (p=.015, OR:3.32, 95%CI:1.25-8.79), and any postoperative arrhythmia (p=.01, OR:3.17, 95%CI:1.31-7.68). Reinterventions occurred for right ventricular outflow tract (RVOT) or pulmonary arteries stenosis (PS) (37 patients (21%): 31 angioplasties and 12 surgical procedures); for aortic arch stenosis (6 patients; 3%), and for coronary artery stenosis (3 patients; 1.7%). Freedom from reoperation was 95%, 89%, 80% and 65% at 1-5-10-15 years, respectively. According to the last follow-up visits of 170 survivors, there were 6 patients (3%) left with moderate or greater RVOT stenosis, 2 patients (1%) with moderate or greater NAVR. A total of 164 patients (96%) of survivors were in the New York Heart Association Class I.
Conclusions: Our results show excellent survival and functional status following ASO for d-TGA, but reinterventions remain frequent especially on the recreated RVOT and pulmonary arteries.
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