Long-term extracorporeal membrane oxygenation in a newborn child after arterial switch operation

Introduction: Neo-aortic root dilation (ARD) is common after arterial switch operation (ASO) for D-loop transposition of the great arteries (TGA). We sought to compare short and long-term outcomes for bicuspid native pulmonary valve (BNPV) patients to those with normal trileaflet variants (TNPV). Methods: A retrospective cohort of TGA patients undergoing ASO at Boston Children’s Hospital from 1989-2018 was analyzed, matching BNPV patients 1:3 with TNPV patients by year of ASO; those with >mild subpulmonary stenosis or complex TGA were excluded. Categorical and continuous variables were compared using Fisher’s exact and Wilcoxon rank sum tests, respectively. Kaplan-Meier analyses with log-rank test compared groups for time to first reoperation on the neo-aortic valve, first occurrence of ≥moderate neo-aortic regurgitation (AR), and ARD defined as root z-score ≥4. Hazard ratios were estimated based on the Cox proportional hazards model. Results: A total of 83 BNPV patients were matched with 217 TNPV. BNPV patients were more likely to have a VSD (75% vs 44%, p <0.001). Early surgical outcomes including hospital LOS (11 vs 10 days) and 30-day mortality (3.6% vs 2.8%) were similar. During median 10 years follow-up, neo-aortic valve reoperation occurred in 4 BNPV (6%) vs 6 TNPV (3%) patients, with no statistically significant difference in time to reoperation. More BNPV patients had AR at discharge (4.9% vs 0%, p=0.014) and during follow-up (13.4% vs 4.3%, HR 3.9, p=0.004), with shorter time to first occurrence of AR (Figure 1A); this remained significant after adjusting for presence of VSD. Similarly, ARD was more common in BNPV (45% vs 37%, HR 1.64, p=0.02) with shorter time to first occurrence (Figure 1B). Conclusions: While patients with BNPV have similar short-term ASO outcomes, AR and ARD occur more frequently and earlier compared with TNPV patients. Further long-term studies are needed to determine whether this results in greater need for neo-aortic valve reoperation.

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Long-term quality of life in adult survivors after the arterial switch operation

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy178 ◽

2018 ◽

Vol 54 (6) ◽

pp. 1001-1003 ◽

Cited By ~ 6

Author(s):

Tyson A Fricke ◽

Benjamin R Loyer ◽

Li Huang ◽

Sophie Griffiths ◽

Nima Yaftian ◽

...

Keyword(s):

Quality Of Life ◽

Arterial Switch Operation ◽

Adult Survivors ◽

Arterial Switch ◽

Switch Operation

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Long-term Outcomes of the Arterial Switch Operation for d-Transposition of the Great Arteries

Progress in Cardiovascular Diseases ◽

10.1016/j.pcad.2018.08.007 ◽

2018 ◽

Vol 61 (3-4) ◽

pp. 360-364 ◽

Cited By ~ 5

Author(s):

Tabitha G. Moe ◽

Dianna M.E. Bardo

Keyword(s):

Arterial Switch Operation ◽

Long Term Outcomes ◽

Arterial Switch ◽

Switch Operation

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The poor long-term outcomes of owl’s eye pulmonary reconstruction technique after arterial switch operation

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa067 ◽

2020 ◽

Vol 31 (1) ◽

pp. 113-120

Author(s):

Mehmet Dedemoğlu ◽

Oktay Korun ◽

Gültekin Coşkun ◽

Fatih Özdemir ◽

Okan Yurdakök ◽

...

Keyword(s):

Arterial Switch Operation ◽

Reconstruction Technique ◽

Reconstruction Method ◽

Long Term Outcomes ◽

Arterial Switch ◽

Switch Operation ◽

Significant Difference ◽

Autologous Pericardial Patch ◽

Group 1

Abstract OBJECTIVES This study aims to compare the early- and long-term outcomes of patients who undergo owl’s eye pulmonary artery (PA) reconstruction to those of patients who undergo conventional PA reconstruction. METHODS From January 2016 to January 2017, 64 consecutive patients underwent an arterial switch operation. The patients were divided into 2 groups in terms of neo-PA reconstruction method: 30 patients who underwent neo-PA reconstruction by owl’s eye technique were defined as group 1 and 34 patients who underwent neo-PA reconstruction by the conventional approach were defined as group 2. In the final model, after propensity matching, 23 patients from each group with similar propensity scores were included in the study. RESULTS There was no significant difference between the groups regarding patient characteristics and operative findings. In the early period, the duration of intensive care unit and hospital stays and the rate of mild neo-pulmonary stenosis (neo-PS) were significantly higher in the owl’s eye group (P = 0.04, 0.04 and 0.03). In the late period, the rate of severe neo-PS and reintervention was significantly higher in the owl’s eye group (P = 0.02 and 0.04). Furthermore, the rates of 3-year freedom from pulmonary reintervention and freedom from moderate–severe neo-PS were significantly lower in group 1 (P = 0.04). In addition, the owl’s eye reconstruction was the only factor independently related to moderate–severe neo-PS in the long term (hazard ratios = 11.2, P = 0.02). CONCLUSIONS We have abandoned the owl’s eye method for neo-PA reconstruction of the neo-PA because of serious complications. According to our series and the literature, reconstruction of the neo-PA with an oversized, pantaloon-shaped fresh autologous pericardial patch is still superior to the other techniques.

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Can we predict potentially dangerous coronary patterns in patients with transposition of the great arteries after an arterial switch operation?

Cardiology in the Young ◽

10.1017/s104795111900204x ◽

2019 ◽

Vol 29 (11) ◽

pp. 1350-1355 ◽

Cited By ~ 1

Author(s):

Krzysztof W. Michalak ◽

Katarzyna Sobczak-Budlewska ◽

Jacek J. Moll ◽

Konrad Szymczyk ◽

Jadwiga A. Moll ◽

...

Keyword(s):

Coronary Artery ◽

Ct Angiography ◽

Coronary Ct Angiography ◽

Arterial Switch Operation ◽

Arterial Switch ◽

Coronary Ct ◽

Coronary Abnormalities ◽

Asymptomatic Patients ◽

Switch Operation

AbstractIntroduction:Coronary artery complications are the main reason for early mortality after an arterial switch operation. Late complications are relatively rare, and there is no consensus regarding the need or indications for routine follow-up coronary artery evaluations or the best first-line assessment modality. The aim of this study was to present the long-term post-operative frequency of coronary abnormalities in asymptomatic patients with transposition of the great arteries discovered by coronary CT angiography and potential “red flags” revealed by other examinations.Patients and methods:A group of 50 consecutive asymptomatic patients who underwent routine long-term coronary artery evaluation after an arterial switch operation according to our institutional protocol were qualified for this study. This routine in-hospital visit included a detailed medical interview, electrocardiography, echocardiography, Holter electrocardiography examinations, and laboratory and cardiopulmonary exercise tests. Patients who showed significant abnormalities were qualified for perfusion scintigraphy.Results:Unfavourable coronary abnormalities were detected in 30 patients (60%) and included ostial stenosis, muscular bridge, coronary fistula, interarterial course, proximal kinking, high ellipticity index, proximal acute angulation (<30 degree) of the left coronary artery, and proximal acute angulation of the right coronary artery. These features could not be predicted based on the medical interviews, surgical reports, or non-invasive screening test results.Conclusion:Complex coronary configurations with potentially dangerous coronary features are common in patients with transposition after an arterial switch operation. Such high-risk patients cannot be identified indirectly, and coronary CT angiography provides accurate information that is useful for post-operative management.

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