scholarly journals Impact of pulmonary artery reduction during arterial switch operation: 14 years follow-up

2020 ◽  
Vol 30 (6) ◽  
pp. 917-924
Author(s):  
Fernanda Lübe Antunes Pereira ◽  
Cristiane Nunes Martins ◽  
Roberto Max Lopes ◽  
Matheus Ferber Drummond ◽  
Fernando Antonio Fantini ◽  
...  
Keyword(s):  
Arterial Switch Operation ◽  
Z Score ◽  
Valve Regurgitation ◽  
Arterial Switch ◽  
Switch Operation ◽  
Long Term Follow Up ◽  
Z Scores ◽  
The Mean

Abstract OBJECTIVES Pulmonary artery/aorta (PA/Ao) size discrepancy plays an important role in the development of neoaortic root growth and valve regurgitation. Since 2004, we started using PA reduction to manage severe great vessels root mismatch at the time of arterial switch operation. The purpose of this study is to evaluate the impact of this technique in the mid- and long-term follow-up. METHODS Patients considered to have severe PA/Ao mismatch (>2:1 ratio) underwent resection of a 3- to 4-mm flap of the posterior PA wall. Patients submitted to this technique were followed up with clinical and image examinations. Echocardiographic findings were reviewed, and Z-scores were recorded to evaluate the incidence and progression of neoaortic root dilatation and valve regurgitation. RESULTS The median (Q1–Q3) follow-up time was 8 years (3–11). Before arterial switch operation, the median (Q1–Q3) Z-score of the PA annulus was 2.90 (2.75–3.75). At the latest follow-up, the median Z-score of the neoaortic annulus was 1.34 (0.95–1.66). The mean difference between the Z-scores of PA annulus and neoaortic annulus was 1.56 (P < 0.0001). The mean value of the sinus of Valsalva was +0.29 ± 1, that of sinotubular junction was +0.71 ± 0.6 and that of ascending Ao was +1.09 ± 0.7. There was no severe dilatation of the neoaortic annulus, neoaortic root or ascending Ao during follow-up. Neoaortic valve regurgitation was none or mild in 93% of patients. CONCLUSIONS PA reduction proved to be a feasible and low-risk procedure to approach PA/Ao mismatch in arterial switch operation. Mid- and long-term follow-up showed a tendency towards stabilization of the neoaortic root dilatation and satisfactory valve performance after the procedure. Further investigation is required with a larger population and longer-term follow-up.

The Switch Back Ross Operation: Report of Two Cases With Good Medium-to-Long-Term Follow-Up

2012 ◽  
Vol 3 (2) ◽  
pp. 244-248 ◽  
Author(s):  
Walter Vicente ◽  
Cesar Augusto Ferreira ◽  
Jyrson Guilherme Klamt ◽  
Paulo Henrique Manso ◽  
Oswaldo Cesar Almeida Filho ◽  
...  
Keyword(s):  
Arterial Switch Operation ◽  
Valve Surgery ◽  
Valve Regurgitation ◽  
Ross Operation ◽  
Switch Operation ◽  
Long Term Follow Up ◽  
Good Medium ◽  
The Ideal

Submitted July 20, 2011; Accepted October 6, 2011. Neoaortic root dilatation and neoaortic valve regurgitation following the arterial switch operation for transposition of the great arteries may ultimately require neoaortic root and/or neoaortic valve surgery. The ideal surgical approach to these lesions remains debatable. Hazekamp et al, in 1997, introduced the replacement of the neoaortic root by the neopulmonary autograft and named this procedure the switch back Ross operation. We report two patients who were successfully treated at our institution with the switch back Ross operation, with good results at, respectively, four- and five-year follow-up.

scholarly journals Long-term follow-up of arterial switch operation with an emphasis on function and dimensions of left ventricle and aorta☆

2009 ◽  
Vol 35 (4) ◽  
pp. 582-588 ◽  
Author(s):  
Kristof D.H.M. Vandekerckhove ◽  
Nico A. Blom ◽  
Shirin Lalezari ◽  
Dave R. Koolbergen ◽  
Marry E.B. Rijlaarsdam ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Arterial Switch Operation ◽  
Arterial Switch ◽  
Switch Operation ◽  
Long Term Follow Up

Abstract 14744: Native Bicuspid Pulmonary Valve in D-loop Transposition of the Great Arteries: Outcomes of the Neo-aortic Valve Function and Root Dilation After Arterial Switch Operation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jane Margaret Irwin ◽  
Geoffrey Binney ◽  
Kimberlee Gauvreau ◽  
Sitaram Emani ◽  
Elizabeth Blume ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pulmonary Valve ◽  
Arterial Switch Operation ◽  
Arterial Switch ◽  
Switch Operation ◽  
Significant Difference ◽  
First Occurrence ◽  
D Loop

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.

Arterial switch operation in patients with transposition and a left-sided aorta

2017 ◽  
Vol 27 (9) ◽  
pp. 1771-1777
Author(s):  
Sachin Talwar ◽  
Robert H. Anderson ◽  
Pradeep Ramakrishnan ◽  
Amolkumar Bhoje ◽  
Saurabh Gupta ◽  
...  
Keyword(s):  
Ventricular Function ◽  
Arterial Switch Operation ◽  
Nyha Class ◽  
Sudden Onset ◽  
Left Ventricular ◽  
Aortic Cross Clamp Time ◽  
Arterial Switch ◽  
Switch Operation ◽  
The Mean

AbstractObjectivesArterial switch operation is the treatment of choice in infants with transposed arterial trunks. It is technically challenging to perform in patients having usual atrial arrangement and concordant atrioventricular connections but having a left-sided aorta. Correction in this setting requires surgical expertise and precision. Here we review our experience with such patients.MethodsBetween January, 2002 and October, 2013, the arterial switch operation was performed in 20 patients in the combination emphasised above. Patient records were analysed in detail for coronary arterial patterns, and for the techniques used for transfer of the coronary arteries and reconstruction of the great arteries. Outcomes were recorded in terms of in-hospital survival and left ventricular function at the most recent follow-up.ResultsAll patients survived the procedure. Ages ranged from 3 days to 18 months, with a median of 75 days; the weight of the patients ranged from 3 to 8.8 kg, with a median of 3.85 kg. The LeCompte manoeuvre was performed in only nine patients. The mean cardiopulmonary bypass time was 157.5±24.9, with a median of 161 minutes, and the mean aortic cross-clamp time was 101.2±23.8, with a median of 102 minutes. Subsequently, two patients died: the first due to a sudden onset of ventricular fibrillation and the second during a crisis of severe pulmonary hypertension. At the last follow-up, which ranged from 23 to 41 months, with a mean of 38.04±2.32 and a median of 38.4 months, all 18 survivors were in NYHA class I, with none requiring cardiac medications and all having normal bi-ventricular function without residual defects.ConclusionWith appropriate technical modifications, patients with concordant atrioventricular and discordant ventriculo-arterial connections with a left-sided aorta can undergo successful anatomical repair.

Is the arterial switch operation as good over the long term as we thought it would be?

2006 ◽  
Vol 16 (S3) ◽  
pp. 117-124 ◽  
Author(s):  
Meryl S. Cohen ◽  
Gil Wernovsky
Keyword(s):  
Clinical Success ◽  
Arterial Switch Operation ◽  
Right Ventricular Dysfunction ◽  
Early Form ◽  
Arterial Switch ◽  
Switch Operation ◽  
Atrial Switch ◽  
Initial Description

Surgical intervention for hearts with transposition, defined as concordant atrioventricular and discordant ventriculo-arterial connections, has been one of the landmark achievements in the field of paediatric cardiac surgery. In the early 1950s, pioneer surgeons attempted to palliate patients with transposed arterial trunks with an early form of the arterial switch operation. As a result of initially dismal outcomes secondary to difficulties with coronary arterial transfer, the unprepared nature of the morphologically left ventricle, and primitive methods for cardiopulmonary bypass, the arterial switch was abandoned in favour of several procedures achieving correction at atrial and venous levels, culminating in the Mustard and Senning operations.1,2These innovative procedures produced the earliest surviving children with transposition. Although the atrial switch procedures achieved widespread acceptance and success during the mid-1960s through the mid-1980s, the search for an operation to return the great arteries to their normal anatomic positions continued. This pursuit was stimulated primarily by the accumulating observations in mid-to-late term follow up studies of: an increasing frequency of important arrhythmic complications, including sinus nodal dysfunction, atrial arrhythmias, and sudden, unexplained death, by the development of late right ventricular dysfunction and significant tricuspid regurgitation in a ventricle potentially unsuited for a lifetime of systemic function by a small but important prevalence of obstruction of the systemic and/or pulmonary venous pathways, and by dissatisfaction with the operative mortality in the subgroup of infants complicated by additional presence of a large ventricular septal defect.3–6As we have already discussed, a number of novel procedures to achieve anatomic correction had been described as early as 1954, but clinical success was not accomplished until 1975, when Jatene and co-workers7astounded the world of paediatric cardiology with their initial description.

Abstract 14902: The Impact of Bicuspid Pulmonary Valve in Aortic Position After Arterial Switch for Transposition of the Great Arteries onNeoaortic Root and Neoaortic Valve Function; Propensity Score Matched Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bobae Jeon ◽  
Eun Seok Choi ◽  
Bo Sang Kwon ◽  
Tae-Jin Yun ◽  
Chun Soo Park
Keyword(s):  
Aortic Valve ◽  
Propensity Score ◽  
Pulmonary Valve ◽  
Arterial Switch Operation ◽  
Z Score ◽  
Arterial Switch ◽  
Switch Operation ◽  
Valve Function ◽  
The Impact

Objective: Neoaortic valve regurgitation which might be related to root dilatation is one of the major concerns following arterial switch operation (ASO) for transposition of the great arteries (TGA). This study investigated the effect of bicuspid neoaortic valve on neoaortic root morphology, function, and the long-term clinical outcomes after ASO for TGA using propensity score matching (PSM). Methods: From 1997 to 2018, 442 patients underwent ASO for TGA. Patients who underwent staged repair (n=15), were repaired at extremely old age (> 1 year, n=9), and died before discharge (n=46), and were lack of echocardiographic data at discharge (n=20) were excluded. Among a total of 352 eligible patients, 18 patients (5.1%) had a BPV. After PSM (1:4), 15 patients with BPV and 60 corresponding patients with tricuspid pulmonary valve were enrolled for analysis. Results: Baseline characteristics in both groups were similar. The median duration of follow-up was 9.9 years (4 months ~ 22.3 years). There was one late death. Freedom from reoperation at 10 years was 93.3 ± 6.4 % in bicuspid group and 88.7 ± 4.4 % in tricuspid group ( p =0.84). Reoperation for aortic valve or aortic root was rarely required during follow-up. Indexed dimension (z-score) of neoaortic annulus was not increased in both groups ( p =0.57) (Figure 1A), although there was a little increasing tendency in z-score of neoaortic sinus without intergroup difference ( p =0.69) (Figure 1B). Deterioration in neoaortic valve function was more prominent in bicuspid group (common odds ratio; 1.40 in bicuspid group [ p <0.01], and 1.12 in tricuspid group [ p =0.03], p =0.03) (Figure 1C). Conclusions: Arterial switch operation could be a safe option in selected patients with TGA associated with BPV without increasing the risk of reoperation. Deterioration of aortic valve function was more prominent in bicuspid group, which suggests that the neoaortic valve function would be deteriorated mainly by valve itself not root pathology.

Sign in / Sign up

Export Citation Format

Share Document