Long-term outcomes of the arterial switch operation for transposition of the great arteries and ventricular septal defect and/or aortic arch obstruction

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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Arterial Switch Operation for Double Outlet Right Ventricle (S, D, L) with Subpulmonary Ventricular Septal Defect

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1299576 ◽

2012 ◽

Vol 61 (04) ◽

pp. 312-315

Author(s):

Che Chen ◽

Bing Song ◽

Debin Liu

Keyword(s):

Ventricular Septal Defect ◽

Right Ventricle ◽

Septal Defect ◽

Arterial Switch Operation ◽

Double Outlet Right Ventricle ◽

Arterial Switch ◽

Switch Operation

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d-Transposition of the great arteries in a 12-year-old child: is arterial switch still an option?

Cardiology in the Young ◽

10.1017/s1047951111001004 ◽

2011 ◽

Vol 22 (1) ◽

pp. 113-115

Author(s):

Jayaranganath Mahima ◽

Devananda Nijagal Shivanna ◽

Anand Subramanian

Keyword(s):

Left Ventricle ◽

Ventricular Septal Defect ◽

Rare Case ◽

Septal Defect ◽

Surgical Approaches ◽

Long Term Outcomes ◽

Transposition Of Great Arteries ◽

Arterial Switch ◽

Muscular Ventricular Septal Defect

AbstractArterial switch surgery for d-transposition of great arteries is usually performed in the first 2 weeks of life before the left ventricle regresses. The arterial switch surgery that helps achieve anatomic and physiologic correction of this condition has better long-term outcomes than other surgical approaches. The procedure may still be attempted at an older age where the left ventricle has not regressed. We report a rare case of a 12-year-old child with d-transposition of great arteries, a remote muscular ventricular septal defect and isolated valvar pulmonic stenosis, which was corrected by an arterial switch surgery.

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Primary Intracardiac Repair of Double Outlet Right Ventricle and Ventricular Septal Defect without Pulmonary Stenosis

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239500300403 ◽

1995 ◽

Vol 3 (3-4) ◽

pp. 103-108

Author(s):

KG Jaya Prasanna ◽

Krishna Subramony Iyer ◽

Rajesh Sharma ◽

Balram Airan ◽

Ivatury Mrityonjaya Rao ◽

...

Keyword(s):

Left Ventricle ◽

Ventricular Septal Defect ◽

Right Ventricle ◽

Septal Defect ◽

Arterial Switch Operation ◽

Pulmonary Stenosis ◽

Double Outlet Right Ventricle ◽

Arterial Switch ◽

Intracardiac Repair ◽

Switch Operation

From January 1991' to May 1994, 29 patients with double outlet right ventricle with ventricular septal defect, without pulmonary stenosis underwent primary intracardiac repair at the All India Institute of Medical Sciences, New Delhi. Patients were classified into 4 groups based on location of the ventricular septal defect. The ventricular septal defect was subaortic in 11, subpulmonary in 13, doubly committed subarterial in 1, and noncommitted in 4 patients. Surgical treatment consisted of intraventricular routing of the left ventricle to the aorta (17), and the left ventricle to the pulmonary artery followed by an arterial switch operation (12). There were 4 (13.9%) early deaths. Follow-up ranged from 3 months to 3 years (mean, 1.5 years). There was no late mortality. Three patients had residual ventricular septal defect, one of whom has undergone reoperation. One patient has a gradient of 25 mmHg across the left ventricular outflow tract. Double outlet right ventricle with subpulmonic ventricular septal defect was found to be a significant risk factor for early mortality (p = 0.03). The subgroup of double outlet right ventricle with subpulmonic ventricular septal defect who had a combination of single coronary artery and post arterial switch operation was particularly prone to pulmonary hypertensive crisis and hospital death (p = 0.002).

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